May 23, 2019
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Lawmakers must fund Medicaid expansion, which is the law, ‘not a suggestion’

Robert F. Bukaty | AP
Robert F. Bukaty | AP
Mainers for Health Care are seen in this file photo at a rally outside the State House prior to Gov. Paul LePage's State of the State address, Tuesday, Feb. 13, 2018, in Augusta, Maine.

The Legislature’s Appropriation Committee is scheduled to meet Wednesday afternoon. Nearly a month after the Legislature prematurely adjourned, without finishing its work, this is a positive development.

Lawmakers left a lot of other unfinished business in Augusta — including a tax conformity bill, which was a priority for Republicans, and funding to maintain wages for direct-care workers, a Democratic priority. Republicans also sought to roll back the state’s $10 an hour minimum wage, although numerous bills to do so failed in the Legislature.

As members of the Legislature’s powerful budget writing committee come back together, there is one thing they must keep in mind: Expanding Medicaid is not negotiable. This means lawmakers must fund the start-up costs to extend health insurance coverage to thousands of low-income working Mainers.

Last year, voters strongly endorsed an expansion of Medicaid in Maine, making the state the 32nd to expand the public health insurance program.

By expanding Medicaid, Maine will make insurance coverage available to as many as 80,000 Mainers. These are people who work but can’t afford health insurance or their employer doesn’t offer it. They are not poor enough or do not have a disability to qualify for Medicaid without an expansion.

Under the Affordable Care Act, the federal government covers 90 percent of the cost. Maine is estimated to receive more than $525 million per year for a state investment of about $55 million annually, beginning in 2021, the first full year of implementation.

Expanding Medicaid means thousands of Mainers who don’t have insurance will be able to access preventative care, vaccinations, addiction treatment, counseling and other needed care. It will also help stabilize the state’s hospitals, many of which are struggling financially.

Gov. Paul LePage, said in February, that he would support expansion if it didn’t raise taxes or take money from other programs. This can be done. Since then, he’s thrown up other roadblocks, including not filing an expansion plan with the federal government, which was due last month.

When negotiations broke down in the Legislature in early May, funding to begin the expansion of Medicaid remained a crucial point of disagreement. The conflict centers on $3.8 million for the Department of Health and Human Services to hire new employees to handle an influx of Medicaid applications when enrollment is set to begin on July 2.

When left August in early May, Democrats and Republicans were entrenched: Democrats put the Medicaid funding in a package of bills they wanted to vote on as a group. Republicans wanted Medicaid expansion to face a vote on its own, which would mean certain defeat after a veto from Gov. Paul LePage, a long-time opponent of expansion.

The problem for Republicans is that expansion is already the law. A judge made that clear last week. So, refusing to begin funding for expansion won’t stop it, it will simply delays access to health care for thousands of Mainers.

“The law is in effect. It’s not a suggestion,” Superior Court Justice Michaela Murphy said last week. “The executive branch has a duty to enforce that.”

Her comments came during a hearing on a lawsuit filed by Maine Equal Justice Partners, an advocacy group that supports expansion, filed to compel the Department of Health and Human Services to begin the process of expanding Medicaid to qualified Maine recipients.

So, with Murphy’s words in mind — expansion is the law, not a suggestion — members of the Appropriations Committee must build any potential agreement around funding expansion.

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