AUGUSTA, Maine — It’s been more than a week since two moderate Republican senators presented a bill to expand Medicaid and save money through a dramatic overhaul of the publicly funded health care system, but the compromise legislation has so far failed to move the needle in the most hotly contested, partisan debate of the year.
At the center of the political firestorm are a handful of GOP lawmakers in the Maine House and Senate, key swing votes needed if Democrats and their allies are to override a certain veto by Republican Gov. Paul LePage, who strongly opposes expansion.
On paper, the compromise legislation, crafted by Assistant Senate Minority Leader Roger Katz of Augusta and Sen. Tom Saviello of Wilton, addressed many of the concerns identified by Republicans.
It includes: a sunset clause, ending the expansion when federal funding dips below 100 percent; an opt-out provision allowing the state to cancel the expansion if the feds fail to live up to their promise to pay the full cost. It beefs up fraud investigations, creates big savings and provides home care services to thousands of mentally disabled Medicaid recipients who have languished on wait lists.
But so far, it seems the bill has failed to bring Republicans on board.
“There are some people we considered on the fence who we’re now getting firm commitments (of opposition) from,” said House Republican spokesman David Sorensen on Tuesday.
On Monday, Rep. Carol McElwee, R-Caribou, voted against the bill in the Health and Human Services Committee. McElwee was one of the Republicans to support a plan to expand Medicaid last year. That plan was passed with bipartisan support but ultimately failed when the Legislature sustained LePage’s veto. McElwee said her constituents have made clear that they oppose the expansion effort.
Sen. Patrick Flood, R-Winthrop, also supported the measure last year. But on Tuesday, he said he’s now “undecided.”
Other Republican targets remain firmly on the fence. Publicly, they are unmoved by the compromise legislation
House Speaker Mark Eves, D-North Berwick, is the Democrats’ lead evangelist for Medicaid expansion, which would extend the benefit to roughly 70,000 Mainers who make less than 138 percent of the federal poverty limit, or about $16,000 for a childless adult. According to the nonpartisan Office of Fiscal and Program Review, the expansion effort comes at minimal cost to the state because it will be funded almost entirely with federal dollars. (Republican lawmakers and LePage’s administration dispute those numbers).
Eves says there are still a lot of conversations going on with Republicans, who have sought additional information on the bill, but that the pressure they’re under by opponents is immense. The targeted lawmakers have been summoned to meet with House Republican Leader Ken Fredette of Newport and Department of Health and Human Services Commissioner Mary Mayhew, who have impressed their reasons for opposing Medicaid.
LePage’s cabinet — commissioners from the natural resource departments, education and labor — have made impassioned pleas against expansion, saying Medicaid spending is already eating into their budgets.
The pressure, Eves said Wednesday, is unending. He said Republicans can’t say hello to a Democratic leader, lest they risk looking soft on Medicaid expansion.
“It’s an awful environment to operate in, and that’s the kind of pressure that’s being exerted on folks right now,” he said.
Meanwhile, a coordinated campaign by proponents of the bill is also underway: The progressive Maine People’s Alliance has mobilized its members, who have descended on the State House every week and made countless calls to legislators. Maine’s hospitals and doctors have come out in favor of the bill. Katz and Saviello are also working behind the scenes, making the case that their bill represents the best chance to get concessions based on “sound Republican principles.”
Both sides bring their own sets of numbers to the table. Proponents point to the OFPR fiscal note showing little cost to the state, and other independent studies that portray the expansion as a shot in the arm for Maine’s economy. Katz said the additional federal funds will create 2,000 jobs throughout the state.
Opponents point to analyses from Mayhew, a fierce opponent of expansion who says the bill would cost the state millions of dollars, or to a study commissioned by the LePage administration, which show expansion costing more than $800 million over 10 years. That study has been besieged with criticism, including from a national analyst who identified a $575 million error. Democrats are actively working to nullify the contract that produced the study.
Both sides vehemently deny the veracity of the other’s numbers. But the numbers are only half the argument.
Democrats and their allies often point to poignant personal stories of Mainers who have no health insurance, who would benefit from expansion. They refer often to the life-saving health care that would be provided to the poorest Mainers.
Republicans have recently trumpeted the online health insurance exchanges as an alternative to expansion. There, about 40,000 of those people who would be eligible for Medicaid under expansion could receive hefty subsidies for the premiums and out-of-pocket costs of private health insurance plans, with some eligible for monthly premiums as low as $5 to $10 per month.
With all the data, stories and arguments coming from both sides, the targeted lawmakers are left with a lot of questions, Katz said Tuesday. He sees that as a good thing. Questions mean they’re still at the table.
“We’re still optimistic that this is going to thread the needle,” he said.
The Senate is unlikely to take up the compromise bill until leaders feel confident they have the votes to pass it, although Senate President Justin Alfond, D-Portland, said it will likely come to a vote sooner or later. Even if the compromise fails, Democrats are sitting on two other Medicaid expansion bills that could be used to force the question several times.
In the meantime, some Republicans are keeping their cards close to the chest. Take for example Rep. Lance Harvell, R-Farmington, who said Wednesday he’d announce his position when it comes time to indicate his vote with the green or red button at his desk.
“They can lobby all they want, but at the end of the day, I’m the one with the button,” Harvell said.
Follow Mario Moretto on Twitter at @riocarmine.