AUGUSTA, Maine — The Maine Legislature on Thursday night approved a Medicaid expansion plan for the third time since March, though the bill is likely doomed to the same fate as its predecessors — death by gubernatorial veto.
The House of Representatives gave the bill final approval with a vote of 94-51. The Senate gave final approval after a 19-14 vote. Neither tally indicates enough support to override a near-certain veto by Republican Gov. Paul LePage.
The bill, as amended by House Speaker Mark Eves, D-North Berwick, was introduced to lawmakers just hours before the vote, prompting complaints from some that there had not been enough time to digest the plan before being asked to vote.
Eves’ amendment offered a new twist on the 16-month-old Medicaid expansion debate by promoting a plan to use millions of federal Medicaid dollars to buy private insurance plans for tens of thousands of newly eligible low-income Mainers.
The tone of debate on the House floor was conciliatory and brief — a stark contrast to the fiery rhetoric and lengthy floor speeches that accompanied previous bills.
“My intention this evening is not to incite another fierce debate but rather lay out the proposal and ask you to sincerely consider it and the lifesaving health care benefits it will have for your constituents,” Eves said during a floor speech.
“I sincerely believe anybody and everybody in this body who says they want coverage for these individuals,” he said. “I know that to be true for every person in this room. This is a pathway to get there.”
Eves was the only member of the House to speak in the bill’s favor. A few Republicans spoke in opposition to the bill. Their chief concern was about the short time frame representatives had to even consider the plan, which Eves sprung on the body during its last regularly scheduled day of the session.
They said the bill should be brought back during the next Legislature, after November’s election, and given a chance to go through the full legislative process.
“The amendment before us is sweeping,” said Assistant House Minority Leader Alex Willette, R-Mapleton. “It’s a massively complex policy proposal that would change our state’s Medicaid system as we know it.”
Noting the extent to which Medicaid expansion had already been debated in the prior 16 months, Sen. James Hamper, R-Oxford, said the debate was “deja vu all over again.”
Democrats emphasized how far removed the plan was from what they originally wanted — a straightforward Medicaid expansion as allowed by federal law. Eves’ bill, they said, was one final effort to try to win Republicans over.
“I will support any reasonable compromise that brings health care to more Maine people,” said Senate Majority Leader Troy Jackson, D-Allagash, in a written statement. “If we can save even one life with this compromise, to me, it’s worth it.”
Rather than simply expanding Medicaid permanently to 70,000 low-income Mainers as originally envisioned by the 2010 federal Affordable Care Act, Eves’ plan would expand Medicaid to those people for one year, while the state establishes a new system to use the money to buy private insurance plans for those recipients.
Starting in summer 2015, about 55,000 of those newly eligible Mainers — all of whom are childless adults — would be shifted to the private plan. Another roughly 15,000 parents would remain on Medicaid, known here as MaineCare.
The private-option system would be administered by the Department of Health and Human Services. If the eligible recipient has access to insurance through their employers, he or she would have to purchase it, and enrollees under the new system would be required to pay co-pays and deductibles on their own.
The bill also includes several compromises already ceded by Democrats: It sunsets after the three years of 100 percent federal funding expires, it automatically self-destructs if federal funding dips below promised levels, and it includes funding for additional welfare fraud investigators.
Eves’ plan represents the fifth pass at Medicaid expansion during the two-year session of the 126th Legislature. Two efforts last year were vetoed by LePage, as was a compromise proposal floated this year by two moderate Republican senators. Republicans in the Legislature stood firm enough in their opposition to uphold the governor’s vetoes.
A fourth effort, spearheaded by Jackson, was enacted by lawmakers this week, and also faces a gubernatorial veto. LePage on Thursday called Eves’ plan “as political as it gets.”
“Leave it to liberals to wait until the absolute last minute to try to pull the wool over everyone’s eyes. The only problem is we all saw it coming,” LePage said in a written statement.
In the House, the bill won over three of the four Republican lawmakers who had supported a previous compromise bill: Reps. Matt Pouliot and Corey Wilson, both of Augusta, and Ellen Winchenbach of Waldoboro. Rep. Jarrod Crockett, R- Bethel, supported the bill in a preliminary vote, but changed his vote on final enactment.
In the Senate, even two Republicans who had supported versions of Medicaid expansion earlier this year — Sens. Roger Katz of Augusta and Tom Saviello of Wilton — opposed Eves’ plan.
With the final votes cast and the bill sent to LePage, supporters of Medicaid expansion are expected to lobby a handful of potential swing-vote Republicans after they return to their districts. Proponents of the bill feel that, with time to make an argument, targeted lawmakers may be more willing to change their votes.
LePage has 10 days, excluding Sundays, to sign the bill, veto it, or let it pass into law without his signature.
Follow Mario Moretto on Twitter at @riocarmine.