AUGUSTA, Maine — Gov. Paul LePage drew a new line in the sand on expanding the state’s Medicaid program Monday, hours after Democrats in the Maine House moved ahead with their second attempt to expand the low-income health insurance program.
The House voted 89-51 Monday morning to support an expansion of Medicaid under the federal Affordable Care Act. The vote, however, fell short of the two-thirds threshold necessary to override a near certain LePage veto.
Responding to the vote, LePage said he wouldn’t entertain a discussion about expanding Medicaid until the state can address a wait list of 3,100 people with developmental disabilities who can’t access certain services in their homes and communities.
The state’s Medicaid program provides those residents with health insurance but the state has been unable to afford housing and other services for them. LePage’s proposal for a new two-year budget includes enough funds to remove 85 people from the wait list.
“The Legislature has ignored the needs of these citizens for years, but now the Democrats want to expand welfare to able-bodied adults with no children,” LePage said in a prepared statement. “Not only is that bad public policy, it’s a disgrace.”
LePage’s statement echoed comments made last week by his health and human services commissioner, Mary Mayhew, and by Republicans on the House floor Monday.
Democrats called the argument a distraction from the real issue.
“If we do not accept the federal funds, we will still have 3,100 on the wait list,” said Rep. Linda Sanborn, D-Gorham, sponsor of the Medicaid expansion bill. “Talk about stubborn facts. Talk about false arguments.”
Five Republicans — Reps. Jarrod Crockett of Bethel, Sharri MacDonald of Old Orchard Beach, Carol McElwee of Caribou, Thomas Tyler of Windham and Windol Weaver of York — voted with Democrats to support the expansion. One Republican co-sponsor of the expansion bill, Rep. Ellen Winchenbach of Waldoboro, voted against it.
The vote came about a week and a half after LePage instantly vetoed a bill passed on party lines that would have signed Maine up for the Medicaid expansion and allowed the state to repay its $484 million debt to 39 hospitals for past-due Medicaid bills.
Monday’s vote was on a bill that solely proposes an expansion of Medicaid under the federal Affordable Care Act, separate from the hospital debt repayment. Democrats amended the bill last week before passing it at the committee level to appeal to Republican concerns that the federal government could back off its promised expansion funding rates. As proposed, the expansion would be repealed if federal funding rates drop below the percentages currently prescribed in federal law.
The measure now heads to the Senate, where it could be further amended to appeal to more Republicans.
Democrats touted an opportunity to expand coverage to those who can’t afford it while the federal government pays 100 percent of costs for three years for about 50,000 newly eligible Medicaid recipients. They also touted the potential economic benefits of expanding coverage.
Republicans largely echoed statements from LePage and others in his administration who have warned against expanding a program that has been on an unstable financial footing in recent years. The issue also needs more study, they said.
“It hurts nothing to wait a few months,” said Rep. Deborah Sanderson, R-Chelsea, referring to a proposal by House Republican Leader Kenneth Fredette of Newport that would set up a study group to explore the state’s expansion options and report back later in the year. “Nothing is etched in stone.”
Rep. Joshua Plante, D-Berwick, said a study “sounds like a delay tactic.”
“We have all the facts. What is clear is that we do not need further studies about Medicaid expansion,” Sanborn said. “We will not learn anything we don’t already know.”
In Maine, more than 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.
Under the Affordable Care Act, the federal government would pay 100 percent of costs for new Medicaid recipients for three years starting Jan. 1, 2014. That 100 percent rate would gradually fall to 90 percent by 2020 and the state would have to make up the remaining share.
The state would receive its standard federal funding rate, which is 62.57 percent, to cover the residents Maine’s Medicaid program already covers. That includes the more than 40,000 parents in Maine who already have Medicaid coverage. The state will continue to get its current federal match rate for them, while states that hadn’t previously expanded Medicaid to parents would receive 100 percent funding to cover them for the first time under Medicaid expansion.
Republicans and LePage have said that represents a penalty to Maine for previously expanding Medicaid coverage.
Rep. Richard Malaby, R-Hancock, said Maine should instead encourage low-income residents to seek private health insurance through insurance exchanges that will soon take effect under the Affordable Care Act. Residents who earn between 100 percent and 400 percent of the federal poverty level, $15,510 to $62,020 for a two-person households, will be eligible for federal subsidies to help them purchase insurance if they don’t already have it.
“I cannot in good conscience choose Medicaid expansion when the exchanges offer such obvious benefits,” Malaby said. “It has no cost to the state. It has positive incentives for individuals to control their own health care spending and, indeed, their own health.”
Democrats countered that low-income people who would otherwise qualify for Medicaid would struggle to afford the premiums and co-payments that go along with private insurance.
“I can tell you that finding $44 a month when all your make is $16,000 a year is not easy,” said Rep. Jane Pringle, D-Windham.
Plus, they said, those who earn less than 100 percent of the federal poverty level wouldn’t qualify for subsidies to help them afford covered offered through exchanges.