AUGUSTA, Maine — Gov. Paul LePage’s administration on Wednesday made clear its fierce opposition to a new Republican-led compromise plan on Medicaid expansion and said the administration would not participate in any negotiations on the bill.
“If expansion is on the table, absolutely not,” said Mary Mayhew, commissioner of the Maine Department of Health and Human Services, when asked whether there was any room for compromise.
During a large press conference, Mayhew was joined by the commissioners of the state’s natural resource agencies, who said growth in the state’s Medicaid program was eating away at their budgets.
The natural resource commissioners — from the Departments of Agriculture, Marine Resources, Environmental Protection and Inland Fisheries & Wildlife — don’t often get involved with policy debates outside their agencies. Their involvement in the Medicaid expansion debate represented the strongest push yet by LePage to gain traction with his core message in recent weeks: that Medicaid spending is “cannibalizing” other state programs.
State general fund spending on Medicaid has grown from $475.5 million in 2002 to $776.2 million in 2012, according to data from the Department of Health and Human Services. During that time, appropriations from the state’s general fund grew from $2.6 billion to $3.1 billion.
The total program cost, including state and federal dollars, has more than doubled since 2000, from $1.2 billion to $2.5 billion.
Mayhew said that increased spending has “come directly at the expense of other significant priorities.”
Agriculture Commissioner Walter Whitcomb said the state’s natural resource agencies had lost $13 million in state funding in just five years, a reduction he attributes to lawmakers’ sweeping appropriations into MaineCare.
“We represent what Maine is widely known for, its iconic image,” Whitcomb said. “But the natural resource agencies have taken it on the chin, financially.”
Patrick Keliher, commissioner of the Marine Resources Department, said spending for his agency has been swept up by lawmakers who needed to cover growing costs of Medicaid each year. That has affected DMR’s ability to manage the state’s lobster population, he said.
“Our ability to do additional research, to make determinations to ensure the information we have right now is accurate, to make future management decisions, is jeopardized — jeopardizing 5,000 license holders and an industry worth upwards of $900 million for our coastal communities,” he said.
Jessamine Logan, DEP spokeswoman, said that in the past 10 years, $7.3 million had been taken from her agency by lawmakers looking to fill holes elsewhere in the budget.
“This means that contaminated properties, which need to be cleaned up and put back into productive use for our economy, remain on a waiting list — potentially contaminating our fisheries and wild, natural resources and habitats,” she said.
Said DIF&W Commissioner Chandler Woodcock: “As Medicaid consumes more funding in our state, our natural resources and the departments that oversee them take the hit.”
Left out of the discussion about the agencies’ budget woes was any mention of revenue — the other half of any budget equation. In 2011, LePage and the then-Republican controlled Legislature passed the largest income tax cut in state history, resulting in a loss of roughly $400 million per year in state revenues.
In an interview Wednesday, Mayhew defended LePage’s tax cuts. She said she did not see the lost revenue as part of the problem facing the state, and that the cuts were a necessary part of the governor’s long-term economic development strategy.
House Speaker Mark Eves, D-North Berwick, an outspoken proponent of Medicaid expansion, said it was unprecedented for the executive branch to politicize the largely bureaucratic commissioners by entangling them in policy debates outside their departments.
“It is out of character for the executive administration to be involved in this way, but it’s the latest example of their fear and concern that this is going to pass,” Eves said. “We have a Republican proposal in front of us that we are considering. That could be the right mix of proposals to get enough Republican support to make sure we insure 70,000 Mainers. I think they are extremely nervous.”
Eves also took issue with the idea that Maine’s Medicaid spending is out of control, pointing to a report by the Kaiser Family Foundation that shows that Maine spends less per Medicaid beneficiary than any other New England state and ranks dead-center nationally. DHHS predicts state Medicaid costs will grow by about 1 percent in this budget cycle.
Later on Wednesday, the Legislature’s Health and Human Services Committee heard a plan by Republican Sens. Roger Katz of Augusta and Tom Saviello of Wilton to expand Medicaid to roughly 70,000 low-income Mainers for three years and hire three or four managed care organizations to administer the state’s Medicaid program, which has more than 300,000 recipients. The committee put off action on the proposal at the end of its meeting.
Under the terms of the Affordable Care Act, the expansion effort would be nearly 100 percent federally funded for the duration of those three years. If the Legislature decides to continue to cover Mainers who make less than 138 percent of the federal poverty limit after that, the federal government would reduce its share to 90 percent.
The two moderate senators see expansion — a key priority for legislative Democrats — as their chance to overhaul MaineCare, and hope a slew of GOP-friendly proposals in their compromise plan will be enough to win the vetoproof majority support needed to pass expansion into law.
Katz and Saviello predict reduced Medicaid costs if their plan is adopted, but Mayhew said Wednesday that “the miraculous savings are not real.” She noted the reduction in the federal share of costs for the current MaineCare population and said the state should expect more of the same.
Follow Mario Moretto on Twitter at @riocarmine.