Liquor, hospital debt and Medicaid expansion headed for vote — all in one bill

The State House in Augusta.
The State House in Augusta. Buy Photo
Posted May 16, 2013, at 6:34 p.m.
Last modified May 17, 2013, at 8:32 a.m.

AUGUSTA, Maine — A sharply divided legislative committee voted Thursday to support a Democratic proposal that ties an expansion of Medicaid to Gov. Paul LePage’s top priority of the legislative session: paying back Maine’s $484 million debt to its 39 hospitals.

The Legislature’s Veterans and Legal Affairs Committee voted 7-5 along party lines to send the full Legislature a bill that proposes repayment of Maine’s hospital debt, a restructuring of the state’s wholesale liquor contract, and an expansion of Medicaid eligibility in the state under the Affordable Care Act.

Democratic Sen. John Tuttle, the committee’s Senate chairman, was not present for Thursday’s vote. Tuttle bucked his party’s leadership last week in saying he didn’t support linking Medicaid expansion and a payback of the hospitals, but he partially backed away from that position Wednesday, saying more than 100 constituents had contacted him in the past week to urge him to back an expansion of Medicaid.

The vote came a day after the Legislature’s Health and Human Services Committee voted 10-4, largely along party lines, to recommend an expansion of Medicaid under the federal Affordable Care Act be attached to LePage’s hospital debt bill.

Before the vote, legislative Democrats and Republicans held dueling news conferences to make their cases, and Gov. Paul LePage continued to pressure Democrats to schedule a vote on his hospital debt bill.

“It is disappointing that Democratic leadership is scheduling press conferences instead of scheduling a vote today on my plan to pay Maine’s hospitals,” he said in a prepared statement. “There is no connection between paying an overdue bill left on my desk when I took office and increasing welfare.”

Republicans in the Legislature have strongly resisted tying the issues together since Democrats stated their intentions late last month to include Medicaid expansion in the hospital debt and liquor contract legislation. House Republican Leader Kenneth Fredette of Newport said the tactic “poisons the well” for conducting other, unrelated legislative business.

“It may be the only way Gov. LePage will accept federal funds for health care,” Patricia Kidder of Sanford said during the Democrats’ Thursday news conference.

Republicans, however, said it’s premature for lawmakers to pass legislation supporting an expansion of Medicaid. While LePage has been reluctant to expand Medicaid, Health and Human Services Commissioner Mary Mayhew has begun discussing a potential expansion with federal officials. In March, Mayhew sent Kathleen Sebelius, the U.S. health and human services secretary, a letter requesting the federal government cover 100 percent of Maine’s expansion costs for 10 years.

“If they’re trying to work on this, why are we trying to close the door on the hard work that the executive branch is doing?” asked Rep. Jonathan Kinney, R-Limington, a Veterans and Legal Affairs Committee member.

House Speaker Mark Eves, D-North Berwick, said Wednesday the LePage administration’s request was “disingenuous” and “never within the realm of reality.”

“We have all the answers to our questions that we had around what was going to be the federal match,” Eves said. “We have our answer, and it’s 100 percent. We got the best deal that we possibly could from the federal government.”

Under the federal health care reform law, the federal government covers 100 percent of costs for newly eligible Medicaid recipients for three years. That 100 percent rate gradually drops to 90 percent by 2020, when the state would make up the rest.

In Maine, about 50,000 adults without children would gain Medicaid coverage if the state opts to expand, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. If the state chooses not to expand, about 25,000 childless adults and parents would lose their Medicaid coverage on Jan. 1, 2014.

Mayhew has argued the Medicaid expansion will, over the long run, saddle Maine’s state budget with millions of dollars in additional costs for a program that is already subject to frequent cost overruns. She said during a hearing last month that the expansion would force the Department of Health and Human Services to hire 93 new administrative staffers to handle the increased Medicaid caseload.

A recent Kaiser Family Foundation analysis, however, projected that Maine would be one of 10 states to see the amount of state funds it spends on Medicaid drop over the next decade — by $570 million, or 3.8 percent — while the federal share of Medicaid expenses would rise by $3.1 billion, or 11.4 percent.

The arguments that consumed the State House on Thursday were largely procedural.

“I’m not saying we can’t do it,” Rep. Michael Beaulieu, R-Auburn, said of the Medicaid expansion before the Veterans and Legal Affairs Committee vote. “I’m saying we shouldn’t do it in the manner in which we’re doing it now. I think this is dangerous.”

“Medicaid expansion does not fall under the purview of the Joint Standing Committee on Veterans and Legal Affairs,” said Sen. Garrett Mason, R-Lisbon Falls. “We don’t understand the complex and detailed matters that are in the materials that we just got an hour ago.”

Fredette said his party will introduce two amendments as the three-part bill makes its way to the full Legislature.

One amendment would remove Medicaid expansion from the legislation. The other would form a study group that would report back to the Legislature by Oct. 1 on the financial impact to the state of expanding Medicaid and the state’s options for expanding the low-income health insurance program.

Fredette first recommended the study group earlier this week as a way to take pressure off lawmakers to decide on expanding Medicaid in the final weeks of the legislative session. The study group, he said, would also look into whether Maine could accept federal Medicaid expansion funds and use them to help low-income residents purchase private health insurance through online exchanges that will come online next year.

“If there’s an affordable option to cover more Mainers, we would approve it,” Fredette said.

Eves called the suggestion “just another excuse” for LePage and Republicans to resist expanding Medicaid.

“It’s just another excuse in a long line of excuses of delaying and denying health coverage for tens of thousands of Mainers,” he said earlier this week.

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