AUGUSTA, Maine — House and Senate Democrats on Tuesday continued to reject Republican efforts to separate an expansion of Medicaid from a plan to pay $484 million in Medicaid debt to Maine hospitals.
The debate was the same in the House and the Senate. Minority Republicans wished to detangle the issues and send the expansion of Medicaid to a study committee. Majority Democrats, who argued that the Medicaid expansion would boost the economy, create jobs and protect vulnerable Mainers, stalled those efforts with twin 20-15 party-line votes in the Senate and a series of 86-55 votes in the House. The bill ultimately passed 20-15 in the Senate and 87-57 in the House, but faces additional votes and the governor’s veto pen. Rep. Stanley Short, D-Pittsfield, was the only lawmaker who broke rank with his party.
The linked bill, LD 1546, went under debate in the House during an evening session in the House of Representatives that lasted well past 8 p.m. Tuesday. Speaker Mark Eves, D-North Berwick, temporarily and rarely passed over the speaker’s gavel to speak in favor of linking Medicaid expansion to hospital repayment.
“Today lawmakers have an opportunity to pay back the debt that is owed to our hospitals and contain the rising cost of health care for our people and our hospitals,” said Eves. “We have an opportunity together to do three things in one bill: help our hospitals, help working Mainers who need health care and help our economy. … This should not be a political issue. We all agree we should pay the hospitals. What we are at an impasse over is health care for tens of thousands of Maine people.”
House Republicans, led by Minority Leader Kenneth Fredette, R-Newport, repeated some of the tactics their colleagues in the Senate attempted Monday, including claiming that the bill had been improperly written and passed by the Health and Human Services Committee, where the concept of paying off back debt to hospitals with proceeds from a renegotiated liquor contract was linked to expanding Medicaid under the federal Affordable Care Act.
“Maine can choose its own path,” said Fredette. “Maine must choose its own path, but the choice we have to make today is a false choice. We must choose what’s best for the people of Maine.”
Fredette and other Republicans argued that Maine should move slowly with the Medicaid expansion because the state might be able to negotiate a better deal.
But Democrats argued that expanding Medicaid to cover 70,000 more Mainers would help the economy, families and avoid more charity care debt for hospitals. Some suggested that giving lifesaving health coverage to Mainers is an issue of morality.
“I ran for my seat here because Washington County is short on affordable access to health care,” said Rep. Katherine Cassidy, D-Lubec. “Too many people in my district are putting off preventative care because they don’t have health insurance.”
Earlier in the day, Senate Republicans repeated long-used arguments that lawmakers need more time to determine the long-term cost of Medicaid expansion.
“We don’t know what this will cost in the long run,” said Sen. Garrett Mason, R-Lisbon Falls, of the Medicaid expansion. “Once we’re in, we’re in. … All Republicans want to know is how much this will cost. If we are going to go down that path, let’s not go down it blind.”
Senate Majority Leader Seth Goodall, D-Richmond, said the cost of the Medicaid expansion is spelled out in the federal Affordable Care Act, but that that wasn’t the only issue that lawmakers should care about.
“We have the opportunity to put the state’s financial house on stronger footing,” said Goodall. “We don’t want people going to the emergency room as their primary care physician. We want them to develop a relationship with their primary care doctor.”
Under the federal health care reform law, the federal government covers 100 percent of costs for newly eligible Medicaid recipients for three years. That 100 percent rate gradually drops to 90 percent by 2020, when the state would make up the rest. Proponents of the expansion say it would cover almost 70,000 Mainers.
In Maine, about 50,000 adults without children would gain Medicaid coverage if the state opts to expand, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. If the state chooses not to expand, about 25,000 childless adults and parents would lose their Medicaid coverage on Jan. 1, 2014.
Republican Gov. Paul LePage identified using a reworked wholesale liquor contract to repay the state’s $181 million share of an overall $484 million Medicaid debt to Maine’s hospitals as his top priority for this legislative session.
After reviewing proposals from the LePage administration and Goodall, the Veterans and Legal Affairs Committee crafted LD 1546, which relies on revenue bonds associated with the reworked wholesale liquor contract to repay the state’s share of the hospital debt, with federal matching funds covering the balance.
LePage and Republicans in the Legislature have strongly resisted adding Medicaid expansion to the hospital debt repayment plan since Democrats stated their intentions late last month to include Medicaid expansion in the hospital debt and liquor contract legislation.
The Health and Human Services Committee and Veterans and Legal Affairs Committee both voted along party lines last week to include Medicaid expansion in LD 1546.
Sen. Doug Thomas, R-Ripley, continued his party’s prolonged attacks on Democrats for linking the two issues.
“Most of the people that we all represent in this state want the hospitals paid,” said Thomas. “If expanding Medicaid was such a good idea, why do we have to tie it to such a popular bill?”
The measure faces more votes in the Legislature before being sent to LePage, who told a Portland television station last week that he would veto the bill if it included a provision to expand Medicaid eligibility.