May 16, 2013

Maine Democrats meld Medicaid expansion, hospital payback

The Maine Hospital Association supports both concepts, but Republicans are angry about tying the two together and hospitals fear a LePage veto.

By Steve Mistler smistler@pressherald.com
State House Bureau

AUGUSTA – Democrats in the Legislature continued their push Wednesday for an expansion of publicly funded health insurance for low-income Mainers and moved to link the expansion with Gov. Paul LePage's plan to pay hospitals about $484 million in outstanding Medicaid reimbursements.

click image to enlarge

In this September 2012 file photo, a patient is wheeled out of Barbara Bush Children's Hospital at Maine Medical Center in Portland. Maine Democrats in the Legislature continued their push Wednesday for an expansion of publicly funded health insurance for low-income Mainers and moved to link the expansion with Gov. Paul LePage's plan to pay hospitals about $484 million in outstanding Medicaid reimbursements.

Gregory Rec/Staff Photographer

In a surprise vote that fell mostly along party lines, Democrats on the Health and Human Services Committee voted 10-4 to link L.D. 1066, a bill to expand Maine's Medicaid program, MaineCare, with the governor's hospital payment plan.

Rep. Carol McElwee, R-Caribou, sided with the Democratic majority, but later issued a statement saying her support was for Medicaid expansion, not for tying the bill to the hospital payback plan.

The expansion would provide health care coverage to an estimated 60,000 low-income parents and to adults without children who are not now eligible for the program.

By linking the two issues, party leaders hope to force LePage and Republicans who support the hospital payment to go along with the Democrat-backed Medicaid expansion.

Wednesday's committee vote signals that Democrats plan to proceed with that strategy, but it does not finalize linking the two bills. The Veterans and Legal Affairs Committee, which is working on LePage's hospital payback bill, will decide later this week if it wants to combine them.

The Medicaid expansion proposal, sponsored by Rep. Linda Sanborn, D-Gorham, has been debated in committee for weeks, with Democrats supporting Maine's participation in the voluntary expansion of the program through the federal Affordable Care Act.

Republicans, including LePage, have resisted those efforts, saying the federal government cannot make assurances that it will keep paying most of the health care costs for the expanded population after an initial subsidy period.

Republicans rejected tying the Medicaid expansion with the hospital payback plan, saying the two issues have different time lines with different consequences.

"Why put the two bills together?" said Rep. Kenneth Fredette, R-Newport. "If Medicaid expansion is such a popular idea, then it deserves an up-or-down vote on its own merits. We've come to the point where we have unanimous consent that paying the hospitals is the right thing to do. Why are we tying a very popular idea to a very controversial issue?"

Democrats say linking the two issues is good for hospitals because expanding Medicaid would reduce charity care associated with emergency room visits for the uninsured.

The Maine Hospital Association supports Medicaid expansion but has rejected Democrats' plan to link it to LePage's debt plan.

The association's lobbyist, Jeffrey Austin, said Wednesday that Medicaid expansion would be a "big win" for the hospitals, but combining the two bills risks a veto by LePage and jeopardizes the debt payment.

Democrats, however, say that tying the two proposals together is the only way to get LePage to agree to Medicaid expansion. The governor has expressed some willingness to explore the issue but he is getting pressure from within his party to reject expansion.

House Speaker Mark Eves, D-North Berwick, has made Medicaid expansion his legislative priority, saying that expanding health insurance for low-income Mainers is the right thing to do "financially and morally."

The Medicaid expansion would cover "able-bodied" parents, and adults who have no children and earn as much as 133 percent of the federal poverty level -- just over $20,500 a year for a two-person household.

Estimates vary, but advocates say the expansion would extend coverage to about 60,000 Mainers. It also would allow more than 10,000 residents who now get health care coverage to keep it come Jan. 1. That group of people is expected to lose access to MaineCare because of eligibility changes the Legislature approved last year to balance the budget.

The federal government would pay 100 percent of the cost of the expansion from 2014 to 2016. In subsequent years, reimbursements would decline gradually to 90 percent of the cost, with the state paying the rest.

On Wednesday, Eves said the Health and Human Services Committee will send a letter to the Veterans and Legal Affairs Committee recommending that Sanborn's bill to expand Medicaid be considered alongside the hospital repayment bill.

"We're excited that this is all coming together and it's happening right now," he said. "It's a follow-through on what we've been talking about related to paying back our hospitals and making sure that we don't get back here in the same situation, covering nearly 70,000 Mainers and addressing charity care, a major cost driver in our health care system."

Sen. John Tuttle, D-Sanford, the Senate chair of the Veterans and Legal Affairs Committee, told the Portland Press Herald last week that he didn't support linking Medicaid expansion to the hospital repayment bill, which relies on revenue from the state's next wholesale liquor contract.

However, Senate President Justin Alfond, D-Portland, said Wednesday that "through many reflections and hearing from many in his district," Tuttle has changed his mind.

"He fully understands the consequences of not accepting these dollars," Alfond said. "It means people's lives are at risk."

Republican leaders reacted angrily to the committee vote Wednesday, saying Democratic leaders didn't alert them beforehand. "Nobody has called us. There's been no smoke signals. Nobody let us know this was coming," Fredette said.

LePage, in a prepared statement, said he was "astounded by this last-minute political maneuvering to make an end run around the Maine people." He called on Democratic leaders to take a simple up-or-down vote on his hospital payback plan.

Although the committee vote was not announced in advance, advocates on both sides have been increasingly active in recent days.

Republicans and LePage's political organization, Maine People Before Politics, recently released statements and a commissioned poll that reaffirmed their position on Medicaid.

On Wednesday, the group Cover Maine Now!, a coalition of health care and progressive groups supporting Medicaid expansion, released a poll designed to show that expanding Medicaid eligibility is popular.

-- State House Bureau Writer Michael Shepherd contributed to this report.

Steve Mistler can be contacted at 620-7016 or at:

smistler@pressherald.com

 

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