WASHINGTON — The White House made an effort Monday to add pressure on Gov. Paul LePage to expand the state’s Medicaid program, by highlighting the thousands of Mainers who would gain health care coverage.
LePage administration officials replied that although they continue to seek more flexibility from federal officials, expanding Medicaid won’t fix major structural problems in the program.
“Why expand a program that is not adequately serving its citizens now?” LePage’s spokeswoman, Adrienne Bennett, said of MaineCare, the state’s Medicaid program.
In the Obama administration’s latest attempt to sway governors who oppose expanding their states’ Medicaid programs under the Affordable Care Act, White House Deputy Press Secretary Josh Earnest said in a conference call that at least 28,000 uninsured Mainers would benefit. Other estimates have put that figure at as many as 60,000 to 70,000.
Earnest was joined on the call Monday by Portland Mayor Michael Brennan and state Rep. Linda Sanborn, D-Gorham, both of whom have lobbied for Maine to take the offer of additional federal money to open up MaineCare to more of the uninsured.
“We have a moral obligation to provide health care to every person in this state,” Brennan said.
“Thousands of Mainers have been left out because of politics,” said Sanborn.
A similar call was held last week with the mayors of Philadelphia, Atlanta and Milwaukee, all of which are in states where Republican governors have not agreed to Medicaid expansion. And two weeks ago, Obama administration officials staged a similar call targeting the governors of Louisiana and Florida.
The White House is struggling to contain growing frustration over other aspects of the health care law, most notably problems with the HealthCare.gov website for people who want to sign up for insurance. Last week, the president also faced the political fallout caused by cancellation notices sent to millions of Americans because their insurance plans would not comply with the law starting in 2014.
The Affordable Care Act directed states to expand their Medicaid programs to close a gap for people who earn too much to qualify for Medicaid but too little to qualify for federal subsidies to help pay for insurance. But the U.S. Supreme Court effectively made that expansion optional. Maine is one of 24 states that have not expanded Medicaid, leaving an estimated 5.4 million lower-income Americans in the gap, according to the White House.
Administration officials, citing figures from the nonprofit Kaiser Family Foundation, estimate that states would save $10 billion over a decade by expanding Medicaid. The federal government will pay 100 percent of the cost for the first three years, with the federal share declining to 90 percent by 2020.
Earnest said during Monday’s call that opponents can “score short-term political points by attacking the Affordable Care Act and Medicaid, or they can save taxpayer dollars” while helping to cover more of the uninsured.
“Expanding Medicaid coverage would give access to quality, affordable health care to millions of residents across the country,” Earnest said.
The LePage administration and some Maine Republican leaders don’t believe those assurances. Repeating claims made throughout the legislative debate over expanding MaineCare – a debate that is expected to resume in the coming session – Bennett questioned whether the federal government would live up to its pledge to cover 100 percent, then 90 percent, of the cost of expansion.
Maine already is struggling to pay for MaineCare from past expansions, she said.
“We have a system currently that is broken and that we are trying to fix,” she said.
The Obama administration has negotiated separate agreements with several states to extend coverage to more low-income people without expanding Medicaid as envisioned under the Affordable Care Act. For example, Iowa and Arkansas sought to use the federal money to offer larger subsidies to low-income individuals who buy coverage through the insurance marketplaces set up under the law.
The LePage administration sought its own deal with the U.S. Department of Health and Human Services, to no avail. Bennett said the governor is “encouraged” by the developments in other states and remains interested in a more flexible approach than a one-size-fits-all expansion.
“It doesn’t seem like there is any flexibility for Maine, at least so far,” she said.
Earnest said the deals negotiated with other states show that the Obama administration is willing to work with states on plans tailored to their insurance markets and the needs of their residents.
Earnest said he couldn’t discuss any specifics for Maine because he wasn’t aware of the state’s particular insurance circumstances, but the administration is “certainly open” to having those discussions with Maine.
“It certainly reinforces the orientation of this administration that we want to work with local officials to design flexible programs that can be tailored to meet the needs of states,” he said.
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