AUGUSTA — Florida lawmakers are weighing whether to participate in the federal health care law’s proposal to expand Medicaid. On Monday, Maine Health and Human Services Commissioner Mary Mayhew attempted to explain why they shouldn’t.

Mayhew testified before the Florida Senate’s committee reviewing implementation of the Affordable Care Act, or Obamacare. Mayhew, appearing via video conference, or Skype, told Florida lawmakers on Monday that Maine’s decision a decade ago to increase Medicaid eligibility did not live up to expectations.

She said it didn’t significantly reduce the number of uninsured or the free care that hospitals have to provide to individuals who can’t afford health insurance.

Mayhew also linked the state’s Medicaid expansion efforts to $484 million in delayed Medicaid reimbursement payments to the state’s 39 hospitals.

Mayhew’s testimony dovetailed with a 20-minute presentation by Tarren Bragdon, the former CEO of the Maine Heritage Policy Center, the conservative advocacy group that has spearheaded several major health care reform efforts with the assistance of the Gov. Paul LePage. Bragdon was also a lead member of the team that helped LePage select his cabinet when he was elected in 2010.

Mayhew was appointed by LePage in February of 2011.


Bragdon is now the head of another conservative advocacy group in Florida, The Foundation for Government Accountability. On Monday, Bragdon said that Maine’s experience with Medicaid was proof that the expansion would be more costly than the federal government and health care advocates have acknowledged.

Mayhew’s testimony comes as Florida and other states consider whether they want to enroll in the health care law’s plan to expand health care coverage for low-income residents. LePage has already ruled out expansion for Maine, telling the Obama administration in November that it doesn’t plan to participate.

Mayhew reiterated the administration’s position on Monday, telling Florida lawmakers that Maine could not be assured that the federal government would deliver on its promise to fully fund states’ Medicaid expansion through 2016 and 90 percent of it after that.

State Sen. David Simmons, R-Seminole County, asked Mayhew if she didn’t believe that “the federal government would live up to its promise.”

Mayhew said that is was difficult to envision the federal government could afford to pay for the program amid ongoing fiscal crises and debates over the national debt.

Other states, particularly those with Republican governors, have wavered on Medicaid expansion, which has been highly politicized as Republicans are under pressure to avoid implementing any provisions of the health care law that are not mandatory. However, some Republican governors, most notably Arizona Gov. Jan Brewer and Ohio Gov. John Kasich, have broken ranks.


Florida is one of eight states that has not decided if it will participate in expansion, according to the Advisory Board Company, a national health organization. Maine is one of 15 states that has either rejected expansion or is leaning against it. Twenty-seven states have either agreed to participate or are leaning in that direction.

With the exception of six states like Ohio and Arizona, the state-by-state breakdown largely aligns with the party controlling the governor’s office.

The remaining ambivalence among Republican governors is due to the fact that the federal government will fund 100 percent of the expansion from 2014 to 2016, gradually declining to 90 percent after that. Accepting federal dollars, an estimated $1 trillion, may seem like a no-brainer, but Republican-controlled states face ideological and political dilemmas.

Expansion of Medicaid, known as MaineCare in Maine, was mandated in the Affordable Care Act as a way to increase coverage for 17 million low-income Americans, including an estimated 37,000 uninsured Mainers. States that didn’t comply with the law’s 2014 deadline to increase coverage faced losing all Medicaid funds.

However, last summer the U.S. Supreme Court struck down the penalty provision, effectively removing the federal stick to increase Medicaid eligibility. But the carrot – millions in federal money – remains a consideration for governors who are facing difficult budgets due to Medicaid.

Proponents of expansion argue that it would save Mainers money because needy residents would no longer have to get charity care in hospital emergency rooms. That care, advocates argue, is often funded through higher premiums for those with private insurance.


In Florida, advocates for expansion have secured a key ally, the Florida Hospital Association, the group representing that states’ hospitals. Hospitals generally support expansion due to the expectation that it will reduce the number of uninsured and charity, or uncompensated, care hospitals have to provide.

On Monday, Bragdon and Mayhew attempted to puncture that narrative, telling Florida lawmakers that increasing Medicaid eligibility has not tamped down charity care provided by Maine’s 39 hospitals.

A recent report by the Portland Press Herald showed that uncompensated care by Maine hospitals has doubled over the last five years, from $94 million to $194 million.

The Maine Hospital Association, which could be the beneficiary of LePage’s proposal to borrow money to pay down the hospital reimbursement debt, has remained silent on Medicaid expansion. 

While Maine increased Medicaid eligibility about 10 years ago,  LePage has since petitioned the federal government to decrease eligibility. Some of those efforts have been rejected by the Obama administration and are a factor in a $100 million Medicaid shortfall currently confronting lawmakers.

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