AUGUSTA — Democrats’ hopes of extending Medicaid health insurance to more than 60,000 low-income and uninsured Mainers dimmed Wednesday after a three-hour debate and potentially decisive vote in the state Senate.

Senators voted 22-13 to pass a compromise bill co-sponsored by two Republican senators. However, supporters fell two votes short of the two-thirds majority – 24 votes – that eventually will be needed to override a certain veto by Gov. Paul LePage.

The prolonged debate showed that positions have hardened among Republicans who are backing the governor’s high-profile bid to defeat the proposal as he heads into his re-election campaign. The outcome also will shape the Democrats’ attempts to retain their majorities in the Legislature in November and unseat LePage.

Although Democrats hoped that a veto-proof margin in the Senate would create momentum for upcoming votes in the House, some party members have already shifted their rhetoric to the campaign by promising an electoral reckoning for Republicans who don’t support the bill.

Banners declaring “We’ll remember in November” were carried in the State House on Wednesday by activists from the Maine People’s Alliance, a liberal activist group that supports Democratic candidates with voter drive efforts.

The bill to expand MaineCare, the state’s Medicaid program, would provide health care coverage for 60,000 to 70,000 people who earn as much as 138 percent of the federal poverty level – just over $15,856 a year for an individual. Maine would be the 27th state to expand Medicaid using federal subsidies available through the Affordable Care Act.

With the expansion now in doubt, so is the prospect that Maine hospitals will receive an economic benefit from extension of insurance to people who now receive free “charity care.”

Expansion of Medicaid eligibility was originally mandatory in the federal health care law, but became optional for states because of a U.S. Supreme Court ruling. The expansion was partially designed to offset an estimated $155 billion in Medicare reimbursement cuts to providers, including hospitals. The Maine Hospital Association estimates that the Medicare cuts will cause an $870 million loss to the state’s hospitals through 2020.

The bill that senators debated Wednesday, L.D. 1487, was sponsored by moderate Republican Sens. Roger Katz of Augusta and Thomas Saviello of Wilton, who aimed to reduce the partisan divide over Medicaid expansion. The debate has raged in Maine for over a year and continues in several statehouses across the country.

Katz highlighted the partisan tension during his floor speech.

“To mention the word ‘expansion’ around here is the political equivalent of throwing off your gloves in a hockey game; it’s an invitation to brawl,” he said. “It’s us versus them, man the barricades and pass the ammunition.”

Katz cited estimates that expansion would produce a $1 billion stimulus to the state’s economy.

Katz and Saviello hoped to attract Republican votes by amending their bill to include provisions to end the expanded coverage after three years of full federal reimbursement unless the Legislature reauthorized it. The main component of the bill would install a managed-care system to reduce costs in a $2.5 billion state program that now serves 320,000 people.

Democrats viewed the managed-care provision as a major concession, but it failed to persuade other Republicans to vote with Katz and Saviello. Sen. Brian Langley, R-Ellsworth, who was considered a swing vote, said he had tried to find a way to support the measure, but couldn’t reconcile the bill with his core views about government-run health care.

Sen. James Hamper, R-Oxford, noted that many proponents of expansion testified last year against the original version of Katz’s managed-care bill.

Hamper said managed care would endanger current savings initiatives that have received grant funding from the federal government. He also challenged an analysis by the Legislature’s nonpartisan budget office, which found that the bill would save the state $3.4 million in the first year alone.

“The bill before us will have immense ongoing costs,” he said.

Democrats stressed the human and economic impacts of expansion, but some acknowledged that their arguments wouldn’t change many minds. “Ideology is a very secure prison,” said Sen. Margaret Craven, D-Lewiston.

Sen. Linda Valentino, D-Saco, cited estimates that expansion would inject $350 million each year into Maine’s economy, including $40 million in York County.

“I don’t see how anyone can vote against the jobs that will come to their counties,” she said.

“It’s not often that we get to vote on something so critical,” said Sen. Colleen Lachowicz, D-Waterville. “This will save lives.”

Republican opponents have questioned whether the hospitals would truly benefit from expansion, citing last year’s bill that repaid providers the state’s $138 million share of backlogged Medicaid reimbursements. The plan used a new state liquor contract to fund a bond that paid down the hospital debt.

“We had to mortgage a lucrative contract to pay for a previous welfare debt,” said Sen. Garrett Mason, R-Lisbon Falls.

Republicans countered Democrats’ claim that a vote against expansion would deny Mainers an opportunity to gain health care coverage. They have urged people who stand to become eligible under Medicaid expansion to instead buy private insurance through the Affordable Care Act. That has drawn criticism from expansion advocates, who have noted that Republican lawmakers in Maine have taken steps to delay or burden the implementation of the federal law.

A provision in the Affordable Care Act allows individuals who earn more than 100 percent of the federal poverty level – about $11,670 per year – to qualify for subsidies to buy private insurance for as little as about $5 per week. Republicans have said they don’t support the Affordable Care Act but they prefer that low-income Mainers have “some skin in the game.”

Democrats have countered that 36,000 people would still fall into a so-called coverage gap because they’re below the poverty level and don’t qualify for subsidized coverage. The Affordable Care Act assumed that anyone below 110 percent would be covered by expanded Medicaid programs.

Democrats also have accused Republicans of encouraging residents with earnings below the poverty level to overstate their projected earnings to obtain subsidized insurance under the Affordable Care Act.

Steve Mistler can be contacted at 791-6345 or at:

smistler@pressherald.com

Twitter: @stevemistler