AUGUSTA, Maine — Gov. Paul LePage is watching closely as Republican governors in other states find ways to expand their Medicaid programs under the Affordable Care Act, but so far LePage is not ready to propose anything that would lead to an expansion in Maine.
However, Assistant Senate Minority Leader Roger Katz, R-Augusta, said his push toward an expansion model acceptable to his GOP colleagues and the executive branch continues. Katz said he’s trying to craft a compromise that would help poor people afford health insurance while addressing concerns that a culture of entitlement arises if people don’t pay a portion of their health care costs.
LePage spokeswoman Adrienne Bennett said Tuesday morning that the governor’s stance on expanding Medicaid under the federal Affordable Care Act has not changed: he wants a better deal from the federal government than the one that is currently proposed. But federal officials have said they can’t sweeten the deal.
“A one-size-fits-all approach is not acceptable and we hope the Obama administration continues to be open to creative solutions that states develop for themselves,” said Bennett in a written statement. “Gov. LePage has consistently advocated for flexibility from the federal government because the current system is broken and financially unsustainable. The LePage administration will continue to evaluate these models and explore options for ensuring quality health care and fiscal responsibility.”
Bennett said Tuesday that her comments do not mean LePage has moved any closer to accepting any form of Medicaid expansion. She repeated often-used arguments that the Medicaid program is already too big — with one in three Mainers participating — and too expensive.
At issue is the federal government’s offer to states to pay 100 percent of the cost of expanding Medicaid programs for three years, ramping down to 90 percent support thereafter. The expansion would cover able-bodied parents and adults without children who earn up to 133 percent of the federal poverty level, which is $20,628 of income per year for a two-person household.
LePage and his Republican allies in the Legislature have argued that accepting the federal offer could lead to out-of-control cost increases in the future that would cannibalize the state’s budget. Some, most notably LePage, have also argued that they don’t trust the federal government to keep its promises.
LePage and Republicans deflected several attempts by Democrats in the Legislature earlier this year to move ahead with the Medicaid expansion. While LePage hasn’t budged much on the issue, Democrats insist that the expansion remains one of their priorities.
Meanwhile, several Republican governors, including those in Florida, Pennsylvania, Michigan, New Jersey, Arizona and Iowa, have either accepted the expansion or at least softened their opposition to it. The Toledo Blade newspaper reported Tuesday that Ohio is moving toward accepting the federal money, despite Ohio Gov. John Kasich’s early opposition.
LePage has tried and failed to negotiate a better deal with the federal government, based on his argument that Maine should receive more support because the state in 2002 expanded Medicaid beyond what the federal government requires. In May of this year, the federal Center for Medicaid Services rejected the LePage administration’s proposal to negotiate a better deal for the state, namely higher matching rates than are offered under the Affordable Care Act.
“These rates are set by law, and CMS has no authority to change the matching rates by regulation or waiver,” wrote CMS.
That was the last time the LePage administration has publicly considered any proposals to expand Medicaid. There have been a range of schemes floated in other states. In Iowa and Arkansas, the proposal is to use the spike in federal Medicaid dollars to subsidize residents’ purchases of private insurance through the ACA’s health care exchanges. Something similar to that, known as Dirigo Health, was implemented in Maine in 2003 under former Gov. John Baldacci, but that program will wind to a close by the end of this year after a systematic dismantling by Republicans.
Bennett said that though LePage hasn’t yet backed any of these compromises, he sees them as evidence that there is room for negotiation.
“Models such as those in Arkansas and Iowa, as well as the plan recently put forth by Pennsylvania Gov. Tom Corbett, indicate that states are seeking flexibility from the federal government before they will consider welfare expansion,” said Bennett.
Katz, a Republican whose compromise proposal to expand Medicaid failed in the Legislature earlier this year, said he’s hopeful the issue isn’t dead. Katz said he favors a system that uses the extra federal dollars to subsidize insurance subsidies for poor Mainers, as long as the recipients are made to pay some form of co-pays for medical services.
“We want to have [subsidy recipients] have skin in the game,” he said. “People are likely to use health care resources more carefully and more prudently if they’re paying part of the cost.”
Katz said he wants the expansion to sunset in three years, before the 100 percent federal funding ends, so that the Legislature can look at the data and decide whether to continue the program.
“The governor has expressed a willingness to look at these things,” said Katz on Tuesday, adding that his discussions around the issue have been informal. “There are conversations going on now and I’m sure those conversations will continue into the next session. I hope there are opportunities for this to become a less partisan issue in the next few months on both sides. There ought to be some good common-sense solution to this that gets away from the partisanship.”