Politics

March 6, 2013

Physicians: Maine's hospitals key to Medicaid expansion

Doctors want to increase eligibility, but they say hospitals are waiting for debt issues to be resolved.

By Steve Mistler smistler@pressherald.com
State House Bureau

AUGUSTA — The group representing Maine's physicians said Tuesday that it stands firmly behind a federal plan to expand health insurance for low-income residents.

However, representatives for the Maine Medical Association acknowledged that the Medicaid expansion plan in the Affordable Care Act won't go far without the support of Maine's 39 hospitals.

Gordon Smith and Andrew MacLean, lobbyists for the Maine Medical Association, told the Portland Press Herald after briefing the Legislature's budget-writing committee that doctors, hospitals and a bipartisan cross-section of lawmakers supported increasing Medicaid eligibility when the Legislature expanded the program voluntarily in 2003.

MacLean said that support likely remains despite the highly partisan politics associated with the Affordable Care Act. Smith agreed, saying Republicans on the Appropriations Committee appeared receptive to expansion.

"They had tough questions, but today was more like a policy symposium than a political hearing," Smith said. "That's encouraging."

Smith told lawmakers Tuesday that doctors still believe Medicaid expansion will reduce the number of uninsured Mainers, and with that, the number of patients jamming up emergency rooms.

After the briefing, MacLean said most of the old support coalition remains.

Absent is the Maine Hospital Association, the trade group representing the state's hospitals. The group supported Medicaid expansion in 2003 because increasing eligibility held the promise of reducing the number uninsured, and the amount of charity care that hospitals provide.

The hospital association has wavered on the current expansion. MacLean said the hospital association's ambivalence is probably due more to providers' hope that lawmakers will take steps to pay off the balance of $484 million in backlogged Medicaid reimbursements than any resistance to expansion.

Said Smith, "That debt is like an albatross. Until it gets settled, I don't think Medicaid expansion (will advance)."

In other states, hospitals have become key in convincing governors to adopt Medicaid expansion.

Maine hospitals have been pushing lawmakers for several years to settle the Medicaid reimbursement backlog. The issue figured prominently in the 2010 gubernatorial campaign, when Paul LePage used the debt as an example of the state's misguided fiscal priorities.

As governor, LePage has proposed paying off the debt. His plan is to issue a revenue bond to pay off the state's $184 million share of the debt and release the balance of federal matching funds. A new liquor contract would be used to pay back the bond.

Democrats say they support Medicaid expansion.

They also say they support paying back the hospitals, but have concerns about LePage's plan because it focuses only on hospitals.

The expansion would make 55,000 more people eligible for MaineCare, the state's Medicaid program, according to an analysis by the Kaiser Family Health Foundation.

Those people would be "able-bodied" parents, and adults who have no children and earn up to 133 percent of the federal poverty level -- just over $20,500 a year for a two-person household.

The federal government would pay 100 percent of the state's costs for the expansion from 2014 to 2016. In subsequent years, reimbursements would gradually decline to 90 percent of the state's costs.

Skeptics question whether the federal government will maintain the 90 percent reimbursement.

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

smistler@pressherald.com

 

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