AUGUSTA — A bill to expand Medicaid to cover more than 60,000 uninsured Mainers was dealt another blow Tuesday as the House voted to pass it 97-49, a single vote less than the two-thirds majority needed to override a certain veto by Gov. Paul LePage.

Last week in the Senate, the bill fell two votes short of a veto-proof margin.

The measure would expand MaineCare, the state’s Medicaid program, to people who earn as much as 138 percent of the federal poverty level, just over $15,856 a year for an individual. It also would establish a managed-care system for the entire MaineCare program.

MaineCare now serves about 320,000 low-income people, including the elderly, the disabled, working parents and their children.

Democrats, who have made Medicaid expansion a policy priority, have emphasized the human impact of not extending coverage to more poor Mainers. Republicans continue to stress the future costs of expanding the $2.5 billion program, which accounts for about 17 percent of state spending.

Although the expansion bill appears doomed, the political rhetoric has escalated. Last week, Democrats said that if Maine does not expand Medicaid, it will increase the likelihood that more than 150 low-income Mainers with chronic illnesses will die. Republicans accused Democrats of calling them murderers.

Rep. Deborah Sanderson, R-Chelsea, said Tuesday that it “boggles the mind” that anyone would consider expansion, given MaineCare’s effect on state budgets.

“If we expand Medicaid, we will experience a fiscal tsunami,” she said.

Democrats who spoke during Tuesday’s floor debate cited the number of people who would gain health care coverage and the fiscal impact in their respective counties.

Rep. Jeff McCabe, D-Skowhegan, the assistant House majority leader, said the bill is about “mercy and help.” He said Republicans are under significant pressure to reject expansion, but he encouraged them to think about the impact on their constituents.

Rep. Matthew Pouliot, R-Augusta, was one of the conflicted Republicans. He said that pressure came from both parties, and that Democrats unfairly portrayed Republicans as not caring about poor people. He said he was disturbed by the partisan nature of the debate.

“I would never compromise on the truth for the sake of getting along with people who only get along when we agree,” he said.

Pouliot voted to support the bill, but said the real health care solution won’t come until the cost of care decreases.

A provision in the Affordable Care Act makes individuals whose earnings are above the federal poverty level – about $11,670 per year – eligible 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 prefer that low-income Mainers have “some skin in the game,” rather than getting free coverage through Medicaid.

Democrats have countered that 36,000 people would fall into a coverage gap because they’re below the poverty level and don’t qualify for subsidized insurance. And advocates for the poor say the private insurance option is still unaffordable because of high deductibles and out-of-pocket costs.

The Affordable Care Act assumed that anyone below 110 percent of the poverty level would be covered by expanded Medicaid programs in their states.

The fight over expansion is expected to play into this year’s legislative and gubernatorial campaigns, as it has in the 21 other states that have not expanded Medicaid through the Affordable Care Act. The federal law originally mandated that all states expand their Medicaid programs, but the U.S. Supreme Court ruled in 2012 that the mandate was unconstitutional and that expansion is optional for states.

Hospitals have been heavily engaged in the debate in state legislatures, including Maine’s, since the court ruling. The expansion was designed in part to offset an estimated $155 billion in Medicare reimbursement cuts to health care 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.

With Medicaid expansion now in doubt, so is the prospect that Maine hospitals will receive any benefit from coverage for people who now receive free “charity care.”

The bill that representatives debated Tuesday, L.D. 1487, was sponsored by moderate Republican Sens. Roger Katz of Augusta and Thomas Saviello of Wilton, who tried to draft a compromise to draw Republican votes.

The compromise includes a provision to end expanded coverage after three years of full federal reimbursement unless the Legislature reauthorizes it. It also includes studies to evaluate the cost and health impacts of expansion, and to explore the feasibility of using federal money to help uninsured Mainers buy private insurance.

The main component of the bill would install a managed-care system to reduce costs. Democrats viewed that provision as a major concession, but it has failed to persuade enough Republicans to support the bill.

In the Senate last week, the bill got one less vote than an expansion bill that was passed by lawmakers and vetoed by LePage last year.

Rep. Heather Sirocki, R-Scarborough, said the managed-care provision would add complexity to an already complex bill. She said its promise of “fancy new cost savings” is a “Trojan horse” that hides the future obligations of Medicaid.

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

smistler@pressherald.com

Twitter: @stevemistler