March 26, 2019
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Maine Democrats push Medicaid expansion to Senate but without key GOP vote from last year

AUGUSTA, Maine — A proposal by two moderate Republican senators to expand Medicaid and incorporate drastic changes in the state’s publicly funded health care program has cleared the Legislature’s Health and Human Services Committee and will now be taken up by the Senate.

The bill — crafted by Assistant Senate Minority Leader Roger Katz of Augusta and Sen. Tom Saviello of Wilton — would accept federal funding under the auspices of the Affordable Care Act to expand Medicaid, known here as MaineCare, to roughly 70,000 low-income Mainers, while also taking steps to implement managed care, a system to outsource the MaineCare program to private for- and nonprofit companies.

Katz and Saviello have put the bill forward as a compromise: Democrats get the Medicaid expansion they tried unsuccessfully to achieve last year, while Republicans get managed care and other cost-saving measures meant to control the growing price of MaineCare.

The nature of that “compromise” is up for debate between committee members: Rep. Peter Stuckey, D-Portland, said that while he opposed managed care last year, the inclusion of Medicaid expansion “provides a lot of ground for me to stand on.”

Rep. Heather Sirocki, R-Scarborough, a staunch opponent of expansion, called the pairing of managed care and Medicaid expansion “a trojan horse.”

The committee vote was expected to fall largely along partisan lines, but it came as a surprise to most that Rep. Carol McElwee, R-Caribou — one of the only House Republicans to support Medicaid expansion last year — switched her vote to oppose the measure. After McElwee’s flip, the final Health and Human Services Committee vote stood at 7-5, with each Democrat supporting the bill and each Republican opposed.

McElwee said her decision was “very difficult,” but the introduction of managed care into the mix put her into the “no” camp. She also said that while she supported MaineCare expansion last year, surveys of her constituents showed they do not.

“I have talked all weekend long to people about this, explaining my feelings, but most of the people who called me were from Portland. They weren’t from The County,” she said. “Caribou is a Republican community, and my constituents do not want MaineCare.”

McElwee’s vote could give pause to majority Democrats in the Legislature, who even with the support of two moderate Republicans still face an uphill battle to muster the Republican support necessary to override a certain veto by Republican Gov. Paul LePage. The Katz-Saviello plan was supposed to win some GOP members over, not drive them away.

Senate Majority Leader Troy Jackson, D-Allagash, represents McElwee’s district in the Maine Senate. In prepared remarks issued after the committee vote, he said thousands of Aroostook County residents stood to benefit from Medicaid expansion.

“We’ve heard about the economic benefits to our state, about the money we’ll save and the jobs we’ll create. Most importantly, we’ve heard about the lives we’ll save and the families we’ll help by passing expansion,” Jackson said. “At the end of the day, this bill is about the people who will benefit: 3,000 veterans; 4,600 Northern Mainers here in Aroostook County; 70,000 people across the state who will have access to the care they need when they need it.”

Under the Affordable Care Act, also known as “Obamacare,” people who earn between 100 percent and 400 percent of the federal poverty limit — about $11,500 for a single, childless adult — are eligible for subsidized private insurance plans available through online health insurance marketplaces.

People living under the poverty line are not eligible for subsidies because the Affordable Care Act originally mandated that all states expand Medicaid to everyone who earns less than 138 percent of the federal poverty limit, about $16,000 for the same single, childless adult. However, a U.S. Supreme Court ruling stated that the federal government could not mandate expansion, leaving it up to each state to decide.

Democrats tried and failed several times to enact expansion last year. They and other supporters point out that the first three years of expansion are nearly 100 percent funded by the federal government before slowly decreasing to 90 percent federal funding by 2020.

The Katz-Saviello plan only expands the program for the three years when Maine will pay the least — only about $683,000, according to the nonpartisan, professional fiscal analysts at the state’s Office of Fiscal and Program Review. Under the plan, expansion would actually save the state $3.4 million in the first year alone, according to Office of Fiscal and Program Review’s projections.

The state’s health commissioner, Mary Mayhew, is a fierce opponent of Medicaid expansion, and disputes the Office of Fiscal and Program Review’s numbers. In a statement Friday, she questioned the agency’s integrity and pushed her own department’s analysis — drawing from a controversial and much-criticized report from the Rhode Island-based Alexander Group — which said the expansion would cost the state millions of dollars.

HHS Committee member Rep. Deborah Sanderson, R-Chelsea, also questioned the Office of Fiscal and Program Review’s projection on Monday, and she blasted the committee’s Democratic leaders for not bringing analyst Christopher Nolan back to the hot seat to answer her questions.

“If we’re going to pass a bill with the budgetary impact that this one has the potential to make, based on potentially false numbers given to us in committee, using inaccurate numbers, you do so at your own peril,” she said. “I think it’s wrong.”

Members of the Office of Fiscal and Program Review, including Nolan, have elected to stay out of the partisan fray that’s erupted over their fiscal note, but House Speaker Mark Eves, D-North Berwick, on Monday defended the budget office.

“The nonpartisan fiscal office has a track record of providing reliable information to the Legislature,” Eves said in a written statement. “Republicans and Democrats alike have been disappointed at times when we haven’t received the fiscal analysis we hoped for. However, the office’s information is calculated on independent facts and math.”

The bill is expected to hit the Senate floor on Wednesday.

Follow Mario Moretto on Twitter at @riocarmine.

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