Gov. Paul LePage’s announcement last week that he was willing to consider expanding government-funded health insurance to 55,000 low-income Mainers has created a new debate about the federal health care law.

This time it’s between Republicans and Republicans.

Like other Republican governors under pressure to reject expansion on political and ideological grounds, LePage already is encountering resistance from his base of conservative supporters.

“Is LePage turning Democrat?” is the title of a commenting thread on the conservative website As Maine Goes. One commenter compared LePage to former Cuban socialist dictator Fidel Castro.

The thread prompted Peter Steele, a spokesman for the governor, to join the discussion and explain LePage’s position further.

“The Governor is a businessman who is open to all reasonable options and is committed to getting the best deal for Mainers,” Steele wrote. “There are several conditions that would have to be met by the federal government to convince the Governor that Medicaid should be expanded.”

LePage initiated the intra-party debate when he said for the first time that he was willing to consider Medicaid expansion, a major provision of the Affordable Care Act, also known as Obamacare. While that was a reversal from a statement he issued in November, it reflects the lure of expansion, which is fully funded by the federal government between 2014 and 2016. Federal funding would cover 90 percent of the program after that, although skeptics note that the post-2016 reimbursement could decrease.

The administration hasn’t specified its terms for agreeing to the expansion, but LePage often has lamented that Maine was penalized for increasing Medicaid eligibility voluntarily in 2003, because federal match funding has declined since then.

Additionally, the Obama administration has shown a willingness to work with states in order to get them to participate in expansion. Florida, for example, has secured federal waivers that allow a private insurance company to manage most of its Medicaid program.

Regardless, LePage and Republican lawmakers are still likely to face pressure from organized and influential allies.

J. Scott Moody, the director of the Maine Heritage Policy Center, a conservative advocacy group with significant influence in the LePage administration, wrote a column last week urging lawmakers to reject the “siren call” of expansion.

Moody echoed arguments made by LePage’s own health commissioner just last month. Mary Mayhew, appearing via Skype, told Florida lawmakers that Maine’s decision a decade ago to increase Medicaid eligibility didn’t reduce significantly the number of uninsured or the amount of free care that hospitals provide to people who can’t afford health insurance — two of the primary arguments made by supporters of Medicaid expansion.

Mayhew also told Florida lawmakers that there was no guarantee that the federal government could deliver on its promise to fund expansion by 90 percent after 2016.

At least eight Republican governors, including Florida Gov. Rick Scott, have bucked pressure from their conservative supporters and opened the door to Medicaid expansion.

Some, including New Jersey Gov. Chris Christie, have paid a political price for doing so.

Christie, courted by some in the Republican party to join the 2012 presidential race, was not invited to speak at last week’s Conservative Political Action Conference, a premier event among Republican activists. A lead organizer explained to the National Journal that Christie had broken with conservatives on key issues, including Medicaid expansion.

Party of two minds

Medicaid continues as a source of ambivalence for Republicans.

There was some bipartisan support when the Legislature voluntarily expanded Medicaid in 2003. Lawmakers were persuaded by the same arguments expansion proponents are making now: Covering low-income Mainers reduces hospital charity care and increases the likelihood that patients will see a doctor regularly rather than wait until their health deteriorates and use an emergency room.

There’s also an economic argument. Kaiser Family Health Foundation recently estimated that Maine would save $690 million between 2014 and 2022 if it expanded Medicaid. The estimate also was cited by the conservative Heritage Foundation.

Medicaid expansion is supported widely by Democrats. House Speaker Mark Eves, D-North Berwick, has said that expansion is the “right thing to do morally, practically and economically.”

The Democratic argument will continue Wednesday when lawmakers hold a news conference to support L.D. 1066. The bill to expand Medicaid in Maine is sponsored by Rep. Linda Sanborn, D-Gorham, a retired family physician.

“A great many of physicians think this is the right thing to do,” Sanborn said Tuesday.

Sanborn’s bill has several Republican co-sponsors. However, the pressure on Republican lawmakers to spurn expansion remains and is expected to increase.

House Republican leader Rep. Kenneth Fredette, R-Newport, last week released a statement saying that “the federal government keeps dangling bait in front of us and we keep on taking it.”

Fredette said Medicaid had given the state “nine-figure cost overruns at Maine’s Department of Health and Human Services and saddled our hospitals with $500 million in unpaid Medicaid bills. Maine cannot afford more broken promises and bait-and-switch hard-sells from Washington.”

The pressure already has gotten to at least one Republican co-sponsor of Sanborn’s expansion bill.

Sanborn said one lawmaker called her Tuesday, saying she was under pressure from the Republican caucus to withdraw her co-sponsorship. She would not say who was exerting the pressure.

“It’s discouraging but not surprising,” Sanborn said. “They (the co-sponsors) haven’t committed to supporting the bill. They just think we should be talking about (Medicaid expansion), but they’re also afraid of the pushback.”

Steve Mistler — 620-7016
smistler@mainetoday.com