AUGUSTA – A bill to extend health insurance to more than 60,0000 low-income Mainers was enacted by the Legislature on Thursday, but it’s still a long shot to become law.
The Senate voted 23-12 to pass L.D. 1066, which would expand Medicaid, the public insurance program for the poor, through the Affordable Care Act.
Medicaid expansion’s link to the federal health care law has produced partisan battles in state legislatures nationwide as Democrats have tried to enact the key component of the law and Republicans, with some exceptions, have opposed it.
The debate in Maine has been no different.
A Republican amendment to L.D. 1066 drew broad support in the Democratically controlled Legislature, passing by strong margins in the House and Senate. But the bill is still several Republican votes short of the two-thirds needed to override an anticipated veto by Gov. Paul LePage.
The Senate vote Thursday was one vote short of that threshold. The House vote was two votes short.
Expansion proponents are still hopeful that they will gain Republican support in the eventual override votes.
“This bill not only addresses the challenges for individuals, it addresses the fiscal challenges that face our state,” said Senate Majority Leader Seth Goodall of Richmond. “Is it perfect for each side of the aisle? No. Is it a compromise in the best interest of the state? I would argue yes. It is what’s right for Maine people.”
Republicans who are open to expansion have been under mounting pressure to oppose it. The LePage administration has made expansion and a bipartisan compromise on the state’s two-year budget a priority for defeat.
In addition to sending staff members to lobby Republicans in the hallways, the governor’s ideological allies have circulated a list of lawmakers who are contemplating voting for expansion. That list includes the lawmakers’ phone numbers. Several of those lawmakers have also received pressure by advocates of expansion.
Sen. Roger Katz, R-Augusta, authored the amendment. It includes a provision that would end coverage after the first three years, during which the federal government pays 100 percent of the costs.
Sen. Garrett Mason, R-Livermore Falls, said that wouldn’t matter because lawmakers wouldn’t have the “stomach to say no to giving 70,000 people” health care.
Sen. James Hamper, R-Oxford, compared expansion to “The Hotel California,” a song by the rock band The Eagles.
“You can check in, Mr. President, but you can never leave,” Hamper said.
In previous debates, Republicans have said that expanding Medicaid is risky because the state has no assurances that the federal government would keep its promise to continue funding coverage for the new recipients at 90 percent after fully funding it for the first three years.
Katz’s amendment tries to address that argument by ending coverage after the 100 percent period ends unless the Legislature authorizes it to continue.
Republican opponents have since moved to a different issue, a list of severely disabled recipients who now receive Medicaid coverage but are waiting for additional services for which they qualify.
Hamper, giving a speech nearly identical to that of Rep. Deborah Sanderson, R-Chelsea, the day before in the House, said expansion would come at the expense of the severely disabled on the list.
Mason said the thousands who would receive coverage through expansion would be “cutting the line.”
The bipartisan budget compromise devotes about $10.4 million to extend services to residents on the waiting list.
The waiting list is the subject of a class-action lawsuit filed against the LePage administration earlier this year. A Superior Court judge ruled May 28 that Maine must provide services to those on the list.
Individuals on the list receive a different class of Medicaid coverage and would be unaffected by expansion.
Medicaid expansion would extend coverage to adults without children who earn as much as $20,500 a year. Under the amended bill, eligibility would expire after three years, when federal reimbursements for the program are scheduled to decline from 100 percent to 90 percent unless the Legislature takes additional action.
In addition to the “sunset” provision, Katz’s amendment would require an outside auditor to assess the broader financial effects of the expansion and increased co-payments for recipients.
The amendment would require the federal government to confirm that Maine will receive the promised 100 percent federal reimbursement for childless adults who enroll in the program in the first three years of expansion, as prescribed in the Affordable Care Act.
The House vote held Wednesday saw three Republicans who previously supported expansion abandon the compromise proposal, resulting in a net gain of one Republican from the vote the week before.
The Senate vote Thursday was identical to the one last week when Katz introduced the amendment designed to address Republicans’ concerns with the Medicaid expansion.
L.D. 1066 now goes to LePage, who is expected to veto the bill.
Steve Mistler can be contacted at 620-7016 or at: