AUGUSTA – Gov. Paul LePage has said that he doesn’t plan to participate in a federally funded plan to expand health care coverage for low-income Mainers. But the issue likely isn’t settled for Democratic leaders in the Legislature, who are working to persuade LePage to join Republican governors who have abandoned their resistance to the Affordable Care Act and agreed to participate in the law’s Medicaid expansion.

The expansion would make 55,000 more people eligible for MaineCare, the state’s Medicaid program, according to an analysis by the Kaiser Family Health Foundation.

Those people would be “able-bodied” parents, and adults who have no children and earn up to 133 percent of the federal poverty level — just over $20,500 a year for a two-person household.

The federal government would pay 100 percent of the state’s costs for the expansion from 2014 to 2016. In subsequent years, reimbursements would gradually decline to 90 percent of the state’s costs.

From 2014 to 2016, the federal payout to states is projected at $1 trillion, assuming that every state participates.

Democratic leaders were reluctant to exert public pressure on LePage, but that is expected to change over the next few weeks as Democrats continue to roll out their public relations campaign.


On Monday, House Speaker Mark Eves, D-North Berwick, said in a prepared statement that Medicaid expansion is the “right thing to do morally, practically and economically.”

Democratic-aligned groups have already increased public advocacy efforts, effectively laying the groundwork for a policy debate that could affect other hot-button issues before state lawmakers.

One issue could be the governor’s plan to pay Maine’s 39 hospitals $484 million in Medicaid reimbursements, $184 million of which is directly owed by the state. The payback plan is a separate issue from Medicaid expansion, but it involves Maine’s hospitals, which figure prominently in the expansion debate.

Eves addressed Maine’s debt to hospitals in his statement, saying Medicaid expansion should be tied to “comprehensive system-wide reform that includes reducing our debt to hospitals, cost controls in our hospitals, and transparency in medical billing.”

Eves also hinted that “unnecessary and exorbitant” costs should be addressed.

States, particularly those with Republican governors, have wavered on Medicaid expansion, which has been highly political with Republicans under pressure to avoid implementing any provisions of the Affordable Care Act that aren’t mandatory.


Several high-profile Republican governors have broken ranks, including New Jersey Gov. Chris Christie, Florida Gov. Rick Scott, Arizona Gov. Jan Brewer and Ohio Gov. John Kasich.

Florida and New Jersey increased to 28 the number of states that have agreed to or are leaning toward Medicaid expansion, according to the Advisory Board Co., a national health organization. Sixteen states, including Maine, have rejected expansion or are leaning in that direction. Six states are undecided.

The Maine Hospital Association has repeatedly expressed ambivalence over Medicaid expansion. On Monday, Maine Equal Justice Partners, a progressive advocacy group for low-income residents, tackled a key point that supporters of expansion hope will sway the hospital association.

The group argued that Maine’s previous experience increasing Medicaid coverage reduced its number of uninsured residents, from 10.6 percent of the population in 2001 to 9.7 percent in 2012. The group said the decline would have been steeper if not for the poor economy and lawmakers’ decisions to freeze Medicaid enrollment.

A former senior policy analyst for Maine Equal Justice Partners, Ana Hicks, is now chief of staff for Eves, the House speaker.

Maine has the sixth-lowest rate of uninsured residents in the country, according to the Kaiser Foundation.


Touting the decline is aimed at enticing support from hospitals. In other states, hospitals have become critical in convincing governors to adopt Medicaid expansion.

Advocates of expansion say it would reduce the number of uninsured Mainers and the amount of uncompensated care that hospitals must provide.

A recent report by the Portland Press Herald showed that cost of uncompensated care by Maine hospitals more than doubled over the last five years, from $94 million to $194 million. The number is even higher when combined with hospitals’ other uncollected debts.

Monday’s briefing by Maine Equal Justice Partners was a rebuttal to Mary Mayhew, LePage’s health and human services commissioner, who last month appeared via video conference to urge Florida lawmakers to reject Medicaid expansion.

Mayhew told them 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 amount of free care that hospitals provide to people who can’t afford health insurance.

Mayhew also said that Maine would not expand Medicaid “at this time” because it could not be assured that the federal government would deliver on its funding promises.


Mayhew, a former lobbyist for the Maine Hospital Association, also linked the state’s past Medicaid expansion to the delayed Medicaid reimbursement payments to its hospitals.

Mayhew’s testimony didn’t convince Scott, Florida’s governor.

Scott, who campaigned against “Obamacare” en route to his election in 2010, announced shortly after the testimony that he planned to participate in the federal Medicaid expansion program.

Mayhew was expected to reiterate her arguments last week before the Legislature’s Appropriations Committee, but the appearance was canceled because of weather.

That committee will hear from the lead lobbyist for the Maine Medical Association on Tuesday. The group represents the state’s doctors. 

This story has been corrected to note the date that the Maine Medical Association will appear before lawmakers.


Steve Mistler can be contacted at 620-7016 or at:

[email protected]

On Twitter: @stevemistler


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