AUGUSTA, Maine — The debate over Medicaid expansion has dominated the 126th Legislature, and it will continue to do so as the session winds down and lawmakers prepare to head back to their districts.
On Thursday evening, the last scheduled day of session, House Speaker Mark Eves, D-North Berwick, will present a last-ditch effort based on a plan approved by Republicans in New Hampshire, ensuring lawmakers take one final vote on his party’s top priority.
Rather than simply expanding Medicaid permanently to 70,000 low-income Mainers as originally envisioned by the 2010 federal Affordable Care Act, the 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, they would have to purchase it, and enrollees under the new system would be required to pay co-pays and deductibles on their own.
Gov. Paul LePage, who has opposed all efforts to expand Medicaid, called the last-minute plan “as political as it gets,” and many members of the House GOP have pledged continued opposition.
In the Granite State, a GOP-controlled Senate and Democrat-controlled House approved a similar plan to subsidize private insurance plans for roughly 50,000 New Hampshirites. Democratic Gov. Maggie Hassan signed the bill into law.
The plan will require a federal waiver, but state officials in New Hampshire are optimistic they’ll receive one, hoping that President Barack Obama’s administration will keen to see state-funded health insurance expanded as envisioned by his landmark health reform law. A similar waiver has already been granted to Arkansas.
The plan has gained traction with Republicans in New Hampshire because it does not permanently expand the Medicaid rolls. Democrats there accepted the plan as a workaround to GOP opposition — an acceptable way to win the political muscle necessary to accept federal cash and expand access to health care.
Eves’ plan is the third push for Medicaid expansion since January, though he called it “dramatically different” from any plan the Legislature has seen before. He said it represents another effort by Democrats to compromise in an effort to win Republican support.
“We’ve listened to the debate,” he said in an interview Thursday. “We’ve made modifications and compromised for the last 16 months, and this is the final opportunity to do this together.” He also drew similarities between the divided government in New Hampshire and in Maine, saying, “If they can do this in New Hampshire, we should be able to do it here.”
Thursday marks the last regular day of the legislative session and is expected to be the last item on the agenda before lawmakers leave Augusta.
A provision of the Affordable Care Act, sometimes referred to as Obamacare, allows the states to expand Medicaid to every resident who makes less than 138 percent of the federal poverty level, or just under $16,000 per year for a childless, single adult. The federal government will pay the full cost of expansion through the end of 2016. After that, its share of the cost will drop, incrementally, to 90 percent.
However, the U.S. Supreme Court in 2012 struck down the provision of the law requiring Medicaid expansion, leaving the decision up to each state.
Eves has been the most vocal proponent of expansion since the 126th Legislature began last year. Since then, the Democrat-controlled Legislature has approved expansion three times, only to be thwarted by LePage’s veto. Another expansion effort, by Senate Majority Leader Troy Jackson, D-Allagash, was enacted this week and faces a near-certain veto.
LePage railed against Eves’ proposal when it was made public Thursday.
“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. “It’s disturbing that liberal leadership refuses to listen to the people of Maine when they say they want real welfare reform. Instead, liberals push policies that will cost Maine taxpayers millions of dollars and put the state deeper into debt.”
Like the plan sponsored by Republican Sens. Roger Katz of Augusta and Tom Saviello of Wilton, Eves’ plan is designed with GOP concerns in mind: If the state is unable to obtain the necessary federal waiver by Aug. 1, 2015, the “bridge” expansion of MaineCare will be repealed. It will also be repealed if the federal fund drops below promised levels. The whole system ends in 2017, when federal funds for expansion dip below 100 percent of cost. At that point, the state will have to decide whether to continue with the private option.
Still, it is unclear whether Eves’ plan will have any more traction with Republicans than previous efforts. Rep. Corey Wilson, R-Augusta, said he supported the measure because it would expand access to health care, lead to higher reimbursement rates for hospitals and keep insurance in the private sector.
Many of the most vocal opponents of Medicaid expansion have already started lining up against the plan.
“This is still just Medicaid expansion, with a new name,” said Rep. Deborah Sanderson, R-Chelsea, the ranking Republican on the Health and Human Services Committee.
She said the scheme in Arkansas was already running into trouble because its federal waiver capped how much Washington would pay for each beneficiary. When costs went up, the state has been left to pick up the tab.
Other Republican members of the Health and Human Services Committee also said a proposal of this scope should have been analyzed by the committee, not sprung as a last-minute House amendment.
“No legislator in their right mind would vote for this program, where it’s had absolutely no time to be vetted,” said Sen. James Hamper, R-Oxford, another committee member.
House Minority Leader Ken Fredette, R-Newport, said that “if Republicans were bringing forward a bill of this significance, at this late a juncture, it would be called a ‘political stunt. … I do think the Speaker is passionate about this issue, but we have already voted on Medicaid expansion, [a] different version of it, several times.”
Eves fought back the claim that his plan was a stunt, saying he couldn’t leave Augusta without knowing he’d tried every option available.
He said he had held off on his amendment until a compromise proposal by Katz and Saviello had played its course. That plan was nixed by LePage last week, and Democrats this week were unable to win the votes to override his veto.
“We have been in a long effort here to provide life-saving health care to these folks,” Eves said. “We’ve always said we’re never going to give up, and we won’t.”
Follow Mario Moretto on Twitter at @riocarmine.