AUGUSTA, Maine — An early morning fix to the state’s 2015 budget shortfall Wednesday, which includes a way to drastically reduce the numbers on a state waitlist for Medicaid coverage, likely had little effect on the debate about whether Maine should expand its low-income health care program, MaineCare.
On Wednesday, Gov. Paul LePage vetoed LD 1487, a bill that expands the state Medicaid system by adding some 70,000 people to the low-income health care rolls, largely with funding available in the federal Affordable Care Act. The bill also sets up a managed care model for Medicaid that some Republicans say will not be cost-effective in improving health outcomes.
Sponsored by Sens. Roger Katz, R-Augusta, and Thomas Saviello, R-Wilton, the bill passed both the House and Senate on simply majority votes of 97-49 and 21-14, respectively.
To overcome the veto, lawmakers would need two-thirds of those voting at the time to support the bill. The veto override votes were unlikely to take place until next week as the Legislature moves toward its adjournment date of April 17.
Both LePage and Republican leaders have repeatedly said they wouldn’t allow for a publicly funded health care expansion before the state eliminates the existing waitlist for some of the most disabled state residents, many of them in nursing home care.
Despite the budget deal Wednesday that closes a $30 million shortfall and funds coverage for most on Maine’s Medicaid waiting lists — a move Republicans hailed — GOP resistance to an overall expansion seems unlikely to soften.
The budget fix, agreed to in a unanimous vote of the budget-writing Appropriations Committee, would help those with some of the most profound medical needs, including a small number facing annual health care costs of up to $100,000 a year, Rep. Peggy Rotundo, D-Lewiston, said.
Rotundo, House chairwoman of the Appropriations Committee, said she is waiting to see how her Republican colleagues react in terms of an overall expansion of Medicaid.
“It’s a significant step forward in addressing the needs of this very vulnerable population as well as addressing the needs of the elderly and frail in our nursing homes,” Rotundo said.
She said both Republicans and Democrats have consistently supported efforts to reduce the waitlist, despite political rhetoric to the contrary.
The deal also increases Medicaid reimbursement rates for nursing homes, many of which have been losing money on Medicaid residents in recent years.
House Speaker Mark Eves, D-North Berwick, said Wednesday he hoped elimination of the waitlist would sway Republicans to join Democrats in overriding the veto of the Medicaid expansion bill.
Eves said the waiting list has been pointed to as key stumbling block for Republicans.
“This is one thing that they have been saying loud and clear that needs to be addressed before they consider a Medicaid expansion,” Eves said Wednesday. “It’s been removed, that barrier has been removed, so I would anticipate and expect they would give the bill a second look.”
And while Republicans have suggested the waitlist was paid for with funds saved from a reduction in MaineCare eligibility for some adults with children, an expansion would add those adults back onto the rolls expanding further the state’s costs.
Eves said that wasn’t the case as the funding to expand MaineCare, for the first three years of the expansion comes largely from the federal government. Eves said there was some misunderstanding regarding that, and information the Legislature’s budget-writing Appropriations Committee received from the state’s Department of Health and Human Services shows those adults could be covered without additional costs.
Still Republicans are balking saying overall problems with implementation of the federal Affordable Care Act coupled with the low numbers of healthy young adults who have signed up to buy their own insurance under the federal exchange meant overall health insurance rates were likely to jump again in Maine in the future.
Rep. Ken Fredette, R-Newport, House minority leader, said his caucus was viewing the waitlist and expansion as two distinct issues.
“While certainly we have talked about the need to address the waitlist as a priority within our state budget, I think the debate around Medicaid expansion and the waitlist are really two separate arguments,” Fredette said.
He said it was ultimately a budget problem for Republicans.
“The question now of getting these people on the waitlist taken care of and the nursing homes does address one issue of funding,” Fredette said.
“But I don’t think it resolves many of the uncertainties that we have seen under the Affordable Care Act both nationally and here in Maine,” he added. “I think that many of those concerns continue to be there about the viability of Medicaid expansion in Maine.”
Fredette said the Affordable Care Act has been fraught with “delay after delay after delay.” Republicans have also argued that while the federal government promises to largely fund the expansion, there will still be nearly $800 million in annual costs to the state once the expansion would be fully implemented under the the Affordable Care Act.
But Democrats have argued that the state, because of the large sums it would pull down from the federal government, will actually save money under the expansion.
They also argue expansion would provide a much needed infusion of money for the state’s economy, and it would lead to the expansion of health care employment in Maine. Both the Maine Medical Association and the Maine Hospital Association have said they support expansion.
Eves said the way the budget deal was crafted also saves the state health care dollars and expanding Medicaid would add as much as $10 million a year to that savings.
He said the argument that removing the waitlist would involve taking health care away from other sector of Mainers was simply misleading.
“The good news is we don’t have to decide to provide health care services to one group over the other, we can do both,” Eves said.