June 21, 2018
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Compromise on Medicaid expansion in sight

Courtesy photo from maine.gov | BDN
Courtesy photo from maine.gov | BDN
State Senator Roger J. Katz, R-Augusta.
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If Maine’s legislative Republicans were looking for a compromise on Medicaid expansion, they got it Thursday.

Sen. Roger Katz, R-Augusta, offered an amendment on the Senate floor to LD 1066 that would allow the state to collect 100 percent federal financing for expansion under the Affordable Care Act for three years and then re-evaluate the effectiveness of the program. The hard sunset provision should hypothetically be enough to draw the support of legislators who seek more state control over extending coverage to low-income individuals.

Still, the 23-12 Senate vote on the amended bill does not show enough backing to override an anticipated veto from Gov. Paul LePage. Even though Katz, along with Sens. Tom Saviello of Wilton and Patrick Flood of Winthrop, voted in favor, they need one more moderate Republican to join them. The Maine House likely needs three. The measure is so close to getting two-thirds support.

The amendment put forward by Katz, who is the assistant Republican leader in the Senate and a former mayor of Augusta, may be workable, though there are reasonable legal questions about whether a state can take 100 percent funding and then run. It’s also not ideal because it doesn’t provide long-term certainty to Medicaid recipients. But we recognize it as an effort to bring conservatives to the table.

In addition to requiring another vote in 2016 about whether to continue expansion, the amendment would create a savings account. Any money that Medicaid expansion saves the state would be placed in the account and used to offset future costs, when the federal government ratchets down matching funding for newly covered individuals to 90 percent. Also, a nonpartisan organization would examine the effects of expansion, so the state can have empirical data on which to base a decision about whether to sign up again.

The changes also would require Medicaid recipients to contribute more of their own money toward their care. The amendment would have them pay co-payments at the maximum level under federal law and would double co-payments if they use the emergency room inappropriately. These are reasonable requests, and a concession on the part of majority Democrats, that should satisfy at least a few more Republican legislators.

Katz clearly addressed the arguments Republicans have made in opposition to expansion. Some people say Maine should wait and try to get a better deal, he said, but the state has received notification from the federal government that it will not provide 10 years of full funding, as LePage had requested.

He told his fellow lawmakers to think of the impact of injecting millions of federal dollars into Maine. Medicaid expansion dollars won’t go to recipients, he said. They will go to physical therapists, nurses and other hospital employees who spend that money in their communities.

He pointed to Republican Florida Gov. Rick Scott who said he could not “in good conscience deny Floridians that needed access to health care” and referenced words by Republican Arizona Gov. Jan Brewer, who said, “We will protect rural and safety-net hospitals from being pushed to the brink by growing their cost in caring for the uninsured.” Medicaid expansion is not a problem for Republican governors in North Dakota, Ohio, Michigan, Nevada, New Mexico or New Jersey.

Others spoke against Katz. Sen. Andre Cushing, R-Hampden, said Maine should not choose to “embolden” the federal government’s plan to “offer more than they can.”

The Affordable Care Act, however, will extend subsidized coverage to low- and middle-income people through health care exchanges. Medicaid expansion would be for the very poorest. Do lawmakers want everyone to have health insurance except those earning less than the poverty line?

Sen. Garrett Mason, R-Lisbon Falls, said there are 3,100 people with developmental disabilities on a waitlist who need coverage and that Medicaid expansion would put able-bodied adults ahead of them. “That borders on insane,” he said.

The waitlist is a major problem, and we look forward to a plan that Mason will support to pay for those individuals’ care. But the waitlist will exist whether Maine expands Medicaid or not. And people who are able-bodied today may not be able-bodied tomorrow.

In the end, Maine’s Republican leaders must examine their conscience, as Katz, Saviello and Flood did. Katz ended his speech by saying, “It is the most difficult decision I have had to make in my time here in the Senate. I cast my vote not with any moral certainty that what I’m doing is right but with the belief that what I have done is the best I can for my state.”

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