Tuesday, March 11, 2014
While Gov. Paul LePage and Democratic lawmakers have sparred over Medicaid expansion for more than a year, a potential compromise could be on the horizon, with the governor now signaling a willingness to consider ideas currently bearing fruit in other states.
With the health insurance marketplace open for business, Outreach Specialist Libby Cummings, at Portland Community Health Center, answers questions on the phone about the new system on Oct. 1.
2013 Telegram file/Carl D. Walsh
Gov. Paul LePage
Any deal would likely revolve around a path followed by states such as Arkansas and Iowa. Both states rejected the by-the-book Medicaid expansion offered under the Affordable Care Act but have worked with the federal government to find other ways of getting health care for low-income residents.
Arkansas, Iowa and other states creating new models tend to share a political dynamic similar to Maine – a divided government with Republican governors and Democrats controlling the Legislature, or vice-versa.
LePage spokeswoman Adrienne Bennett told the Maine Sunday Telegram last week that the governor is evaluating substitute plans taking hold in other states. The Republican governor also credited the Democratic Obama administration for being “open to creative solutions.”
“Gov. LePage is aware of and understands the details of these alternatives, which have been developed in other states,” Bennett wrote in an email. “Models such as those in Arkansas and Iowa, as well as the plan recently put forth by Pennsylvania’s Gov. Tom Corbett, indicate that states are seeking flexibility from the federal government before they will consider welfare expansion. A one-size-fits-all approach is not acceptable and we hope the Obama administration continues to be open to creative solutions that states develop for themselves.”
The administration does not have a specific proposal, but Bennett emphasized that LePage values the flexibility that federal officials have demonstrated in their dealings with other states on Medicaid expansion.
“Gov. LePage has consistently advocated for flexibility from the federal government because the current system is broken and financially unsustainable,” Bennett wrote. “The LePage administration will continue to evaluate these models and explore options for ensuring quality health care and fiscal responsibility.”
‘IT REQUIRES COMPROMISE’
Rep. Richard Farnsworth, D-Portland, House chairman of the Legislature’s Health and Human Services Committee, welcomed the governor’s openness on the issue.
“I am open to working with (LePage),” Farnsworth said. “We’ll test this out and see if he is serious.”
Farnsworth said a new way of thinking about solving the problem is essential.
“We’re not going to get anywhere if we do things the way we did them last time,” Farnsworth said. “We have to take a look at ways we can make this happen. It requires compromise, plain and simple.”
Alternative proposals are also starting to take root in other states, including New Hampshire and Pennsylvania.
The federal government has to approve all alternative plans to Medicaid expansion, which is a key part of the original design of the Affordable Care Act. As part of a 2012 U.S. Supreme Court decision upholding the law, states could opt out of Medicaid expansion. About half of the states, including many with Republican governors, have chosen to forgo expansion.
The Maine Legislature voted to approve Medicaid expansion earlier this year, but LePage vetoed the bill. Although the federal government would have reimbursed 100 percent of expansion costs through 2016, the governor argued that there were no guarantees of longer-term reimbursement, and that Maine was already more generous than most states with Medicaid and could not afford to shoulder additional costs.
In the wake of states’ decisions on expansion, the Obama administration has embraced the idea of state-specific solutions to improving access to health care for poor people, experts say. And Republicans have shown a willingness to build systems hewing closer to conservative principles.
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