AUGUSTA — House Speaker Mark Eves and the Democratic controlled Legislature made a last-ditch effort Thursday to expand Medicaid health coverage to more than 60,000 Mainers.
The latest attempt – the Democrats’ fourth – faces the same obstacles as the others: a certain veto by Gov. Paul LePage and Republican opposition that has helped the governor sustain three previous rejections.
On Thursday, the early votes and rhetoric forecast a similar ending. The House approved the bill, 94-51, but the margin was six votes short of the two-thirds majority that would be needed to override a veto. The Senate voted 19-14 to approve the bill, also short of the override threshold.
The latest expansion bill would take federal money allocated for Medicaid expansion under the Affordable Care Act and use it to help uninsured Mainers buy private insurance. The proposal, introduced as the legislative session draws to a close, differed from three other Medicaid expansion bills because the federal funds would be used to help low-income Mainers purchase private insurance coverage in the new federal marketplace rather than simply expanding eligibility for the state’s Medicaid program, known as MaineCare.
The proposal, L.D. 1578, is similar to an approach taken in New Hampshire and in Arkansas. Those efforts followed exhaustive study and debate and ultimately emerged as a compromise between Democrats, who support expansion, and Republicans, who have criticized Medicaid for inefficiencies and cost overruns.
Eves, who introduced the proposal from the House floor, said the proposal was a final good-faith effort to provide health care coverage to Mainers.
“My intention is not to score political points, but to have a conversation,” said Eves, adding the proposal was a market-based solution supported by Republicans that achieved the goal of both parties to extend health care coverage to more people.
He added, “We all want to do the right thing.”
Rep. Deborah Sanderson, R-Chelsea, said Eves was right that both parties wanted people to have health insurance but the proposal was too complicated and not properly vetted.
The proposal received a cool reception from the LePage administration. Mary Mayhew, the governor’s health commissioner, said, “It is impossible to thoughtfully evaluate a proposal of this magnitude when it first sees the light of day as the Legislature prepares to adjourn.”
LePage slammed the bill in a written statement.
“Leave it to liberals to wait until the absolute last minute to try to pull the wool over everybody’s eyes. The only problem is we all saw it coming,” LePage said. “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.”
Should the proposal somehow garner enough Republican votes to overturn a veto by LePage and become law, the bill would require the state to apply for a waiver by Dec. 1 to use the federal funds for the so-called private option. According to Eves’ press statement, the state would provide bridge coverage until the private option is approved. If a waiver is not approved by July 1, 2015, coverage would end in 90 days.
The federal government has approved a similar waiver in Arkansas. The New Hampshire waiver is still pending and the U.S. Department of Health and Human Services has been petitioned by that state’s congressional delegation to approve it.
Twenty-seven states and the District of Columbia have expanded Medicaid, either through their existing state programs or the private option. Twenty-one others, including Maine, have not. Four others are considering expansion.
The Democratic controlled Legislature has managed to enact previous expansion bills with some bipartisan support, but not enough to overcome resistance from the LePage administration and a majority of Republican lawmakers.
The issue has proven politically divisive, in Maine and other states, because Medicaid expansion is a key component of the Affordable Care Act. The federal law was designed to increase health care coverage by mandating that most Americans buy health insurance. The expansion component specifically targeted low-income people who can’t buy private insurance.
Under the Affordable Care Act, the federal government offered to reimburse states for 100 percent of the cost of expansion for at least three years, then gradually reduce reimbursements rates to about 90 percent.
Many lower- and middle-income Americans qualify for subsidies to help them buy coverage plans on the health insurance marketplace set up under the act. But subsidies are not offered to some of those living at or below 138 percent of poverty level – $15,856 or less for an individual – because the act assumed they would be covered through a nationwide expansion of Medicaid.
In Maine, that means about 24,000 people will neither be covered by Medicaid, nor qualify for subsidies under the act.
The U.S. Supreme Court struck down the Medicaid expansion mandate in 2012, leaving it up to individual states to decide if they want to extend coverage to low-income people. Since then, a fierce political fight has raged in statehouses across the country as opponents and proponents of the Affordable Care Act have poured resources into a debate that may play a role in the success of the federal health law.
Maine Democrats have fallen several votes short of the veto-proof margin on their previous three attempts to expand Medicaid. Among those efforts was a Republican-sponsored proposal that would have established a managed care system for all current 320,000 beneficiaries, an effort to control costs in the $2.5 billion program.
Rep. Kenneth Fredette, R-Newport, the House minority leader, said in a statement that he expected Eves’ proposal would likely meet the same fate as other expansion bills.
“Speaker Eves and I may have strong differences on economic and health policy, but I would like to commend him for his fair and heartfelt effort on behalf of a cause he believes in,” Fredette said in a statement. “I believe just as strongly that Medicaid expansion would be bad for our state’s economy and budget, and yesterday’s public poll indicates that an increasing number of Mainers agree as they begin to learn more.”
LePage now has 10 days to sign, veto or allow the proposal to go into law without his signature. Two-thirds of lawmakers present and voting are required to override a governor’s veto. An override requires votes in the House and Senate.
Steve Mistler can be contacted at 791-6345 or at: