We have tried to present reasonable arguments to Maine’s Republican lawmakers to urge them to accept federal funding to expand Medicaid. We have emphasized the good financial deal Maine is projected to get, according to independent, outside analyses. We have highlighted the obvious, practical health reasons why tens of thousands more Mainers should have access to care. We criticized lawmakers when they blocked a previous Medicaid expansion proposal.
Some GOP lawmakers have changed their minds and their votes. A revised bill before the Legislature is simpler now, as it no longer ties expansion to a plan to pay Maine’s hospital debt. It also now addresses a concern voiced among Republicans — that the federal government won’t abide by the Affordable Care Act and pay 100 percent of expansion costs for three years and then ratchet down to and remain at 90 percent funding thereafter — and adds a provision to repeal expansion if federal funding drops below those prescribed levels.
Is it enough? The Maine House did not cast enough votes in favor of the measure on Monday to override an anticipated veto by Gov. Paul LePage. And previous legislative override votes this year don’t offer hope: Every time, even if bills garnered unanimous support, Republican legislators have stepped aside and allowed LePage’s vetoes to stand. By doing so, they have shown their constituents they are more willing to bend to an unreliable leader than stick up for what they know is just.
There is still a little time, however, for a few Republicans to stand up for their communities’ poorest — on whose doors they’ve knocked and asked for votes. It will take only 12 Republicans in the House and Senate for the bill to be veto-proof; five are already on board. Additional votes on LD 1066 will be scheduled in the coming days.
As Republicans negotiate and weigh their options, we offer the following scenario for their consideration, which will happen if Maine does not expand Medicaid. One of their neighbors, who earns less than $11,490 per year, will read about or see an advertisement on TV this fall encouraging Maine residents like her to sign up for health insurance. Under the federal health reform law, she will learn, the U.S. is trying to cover all people, to help lower the costs of health care. She will also learn that assistance is available to help low-income individuals afford insurance.
She will try to sign up. She will be denied. Why? Because she is among the poorest of the poor. Meanwhile, she will come to know about friends or neighbors who earn more than she. She will learn they applied for insurance and were eligible for subsidies to help them pay for coverage.
Whether she is sick or not, she will be upset. She will ask state officials to explain why people who earn more than she does are eligible for assistance, while they reject coverage for the state’s most vulnerable population. She will ask why she would be eligible for assistance if only she earned more money. What will officials say to the thousands of others also in her situation? Trying to explain will be a nightmare, especially since the federal government would pay for all the costs of insuring this population for three years.
If Maine lawmakers do not vote to expand Medicaid, low-income and middle-class people will be eligible for help paying for insurance, but the very poorest will not. People who earn incomes between 100 and 400 percent of the federal poverty level will receive coverage that is subsidized by federally funded tax credits through health insurance exchanges. Those earning less than 138 percent of the poverty line were originally supposed to qualify for Medicaid, but the U.S. Supreme Court ruled expansion optional. So if Maine doesn’t choose to expand, the poorest residents will go without coverage.
Maine should thank five Republicans in the House — Jarrod Crockett of Bethel, Sharri MacDonald of Old Orchard Beach, Carol McElwee of Caribou, Thomas Tyler of Windham and Windol Weaver of York — who voted to support expansion on Monday. The House will need a minimum of three more Republicans in the House. The Senate will need support from a minimum of four. Fairly distributed health care coverage could become a reality if just a few lawmakers say no to LePage and yes to their constituents.