AUGUSTA — A compromise bill to expand the public health insurance program for the poor passed in the House on Wednesday without significant support from Republicans, who have been urged by Gov. Paul LePage to reject the key component of the federal health care law.

The House voted 97-51 to approve an amended version of L.D. 1066, a bill that supporters say would extend health insurance to more than 60,000 Mainers through MaineCare, the state’s Medicaid program.

The amended bill is identical to the proposal that the Senate passed 23-12 last week.

Three Republican senators supported the measure after Sen. Roger Katz, R-Augusta, proposed the amendment to address Republicans’ concerns.

Five House Republicans voted for the original version of L.D. 1066 last week. Six supported the amended bill Wednesday. Democrats, who have majorities in the House and Senate, are still hopeful that Republicans will help them override an almost certain veto by LePage.

“We were able to come together with Republicans to get a good deal for Maine,” said Rep. Linda Sanborn, D-Gorham, the bill’s lead sponsor.

“We can’t pass up this deal. If we don’t accept this money, Maine people will lose health care while other states accept these dollars.”

In previous debates, Republicans have said that expanding Medicaid through the Affordable Care Act is risky because Maine has no assurance that the federal government will keep its promise to continue funding coverage for the new recipients at 90 percent after fully funding it for the first three years.

Katz’s amendment is designed to address that issue by including a “hard sunset” that would end coverage after full federal funding ends unless the Legislature authorizes it to continue.

On Wednesday, Republicans moved a different issue to the center of their opposition: a waiting list of severely disabled recipients who qualify for Medicaid services.

The waiting list is the subject of a class-action lawsuit filed against the LePage administration earlier this year.

During Wednesday’s floor debate, Republican opponents said they are unwilling to participate in Medicaid expansion until lawmakers deal with the list.

Rep. Deborah Sanderson, R-Chelsea, tried to amend the bill to provide Medicaid to severely disabled Mainers on the waiting list. She said supporters of Medicaid expansion have been “derelict in their duty” by neglecting those people, who have been “shoved into the shadows.”

A bipartisan budget compromise devotes about $10.4 million to extend services to those residents. Rep. Jeff McCabe, D-Skowhegan, said the budget doesn’t go far enough. But he said the language in Sanderson’s amendment conflicts with L.D. 1066, making the bill unpassable.

As proposed, Sanderson’s amendment would cost $35 million. It was defeated Wednesday, 88-61.

The class-action lawsuit, filed in January by 18 eligible recipients and their guardians, alleges that the administration and the Department of Health and Human Services violated federal provisions of Medicaid that require the state to provide coverage to qualified physically and mentally disabled residents.

According to court documents, 493 residents with intellectual disabilities and autism were on a waiting list for MaineCare along with another 830 who qualified for home and community-based care. Maine Superior Court Justice Michaela Murphy ruled May 28 that the state is obligated to provide Medicaid to those residents.

It’s not clear if the compromise expansion will gain momentum. With the Legislature’s June 19 statutory adjournment fast approaching and major bills still outstanding, the bill appears to be the last chance to expand Medicaid through the Affordable Care Act this session. 

Medicaid expansion would extend coverage to adults without children who earn as much as $20,500 a year.

In addition to the “sunset” provision, Katz’s amendment calls for an outside auditor to assess the broader financial effects of the expansion and increased co-payments for recipients.

The amendment would require the federal government to confirm that Maine will receive the promised 100 percent reimbursement for childless adults who enroll in the program in the first three years of expansion, as prescribed in the Affordable Care Act.

Republicans argued that the sunset makes a bad bill worse. Some said lawmakers wouldn’t muster the political courage to eliminate health care coverage for people once they had provided it, even if the program proved costly.

Republicans who are open to expansion have been under mounting pressure to oppose it.

Opponents have circulated a list of Republican lawmakers who are contemplating voting for expansion. That list includes the lawmakers’ phone numbers and a message urging them to reject Medicaid expansion.

The lobbying has had mixed results.

Two Republican co-sponsors of L.D. 1066, Sens. Brian Langley of Ellsworth and Rodney Whittemore of Skowhegan voted against the compromise bill in the Senate last week.

Others have said they will continue to support expansion. L.D. 1066 requires an additional vote in the Senate before going to LePage’s desk.

Senate President Justin Alfond, D-Portland, and House Speaker Mark Eves, D-North Berwick, said Wednesday that they are hopeful the bill will gain additional Republican votes.

Steve Mistler can be contacted at 620-7016 or at: [email protected]
Twitter: @stevemistler