March 20, 2013

LePage spurs new debate on Medicaid expansion

But the resistance comes from some Republicans, after the governor reverses his stance from November.

By Steve Mistler smistler@pressherald.com
State House Bureau

Gov. Paul LePage's announcement last week that he was willing to consider expanding government-funded health insurance to 55,000 low-income Mainers has created a new debate over the federal health care law.

This time it's between Republicans and Republicans.

LePage, who is inclined to reject an expansion of Medicaid on political and ideological grounds, is already encountering resistance from his base of conservative supporters.

"Is LePage turning Democrat?" is the title of a comment thread on the conservative website, As Maine Goes. One commenter compared LePage to former Cuban socialist dictator Fidel Castro.

The thread prompted Peter Steele, a spokesman for the governor, to join the discussion and further explain LePage's position.

"The Governor is a businessman who is open to all reasonable options and is committed to getting the best deal for Mainers," Steele wrote. "There are several conditions that would have to be met by the federal government to convince the Governor that Medicaid should be expanded."

LePage initiated the intra-party debate when he said for the first time that he was willing to consider Medicaid expansion, a major provision of the Affordable Care Act, more informally known as Obamacare.

While the statement was a reversal from a statement he issued in November, it reflects the lure of expansion, which is fully funded by the federal government from 2014 through 2016. Federal funding would cover 90 percent of the program after that, although skeptics note that the post-2016 reimbursement could decrease.

The administration hasn't specified its terms for agreeing to the expansion, but LePage has often lamented that Maine was penalized for increasing Medicaid eligibility voluntarily in 2003 because the federal match has declined since then.

This time, however, the Obama administration has shown a willingness to work with states to get them to participate in expansion. Florida, for example, has secured federal waivers that allow a private insurance company to manage most of its Medicaid program.

Regardless, LePage and Republican lawmakers are still likely to face pressure from organized and influential allies who oppose expansion.

J. Scott Moody, director of the Maine Heritage Policy Center, a conservative advocacy group with significant influence in the LePage administration, wrote a column last week urging lawmakers to reject the "siren call" of expansion.

Moody echoed arguments made by LePage's own health commissioner just last month. Mary Mayhew, appearing via Skype, told Florida lawmakers that Maine's decision a decade ago to increase Medicaid eligibility didn't significantly reduce the number of uninsured or the amount of free care that hospitals provide to people who can't afford health insurance -- two of the primary arguments made by supporters of Medicaid expansion.

Mayhew also told Florida lawmakers that there was no guarantee that the federal government could deliver on its promise to fund expansion by 90 percent after 2016.

At least eight Republican governors, including Florida Gov. Rick Scott, have bucked pressure from their conservative supporters and opened the door to Medicaid expansion.

Some, including New Jersey Gov. Chris Christie, have paid a political price for doing so.

Christie, courted by some in the Republican party to join the 2012 presidential race, was not invited to speak at last week's Conservative Political Action Conference, a premier event among Republican activists. A lead organizer explained to the National Journal that Christie had broken with conservatives on key issues, including Medicaid expansion.

The Kaiser Family Health Foundation recently estimated Maine would save $690 million between 2014 and 2022 if it expanded Medicaid. The estimate was also cited by the conservative Heritage Foundation.

Medicaid expansion is widely supported by Democrats. House Speaker Mark Eves, D-North Berwick, has said expansion is the "right thing to do morally, practically and economically."

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