AUGUSTA — Democrats in the Legislature continued their push for an expansion of publicly funded health insurance for low-income Mainers on Wednesday and moved to link the expansion with Gov. Paul LePage’s plan to pay hospitals about $484 million in outstanding Medicaid reimbursements.

In a surprise vote that fell mostly along party lines, Democrats on the Health and Human Services Committee voted 10-4 to link L.D. 1066, a bill to expand Maine’s version of Medicaid, or MaineCare, with the governor’s hospital payment plan.

Rep. Carol McElwee, R-Caribou, sided with the Democratic majority but later issued a statement saying her support was for Medicaid expansion, not for tying the bill to the hospital debt payback plan.

The expansion would provide health care coverage to an estimated 60,000 low-income parents and adults without children who are not now eligible for the program.

By linking the two issues, party leaders hope to force LePage and Republicans who support the hospital payment to go along with the Democratic-backed Medicaid expansion.

Wednesday’s committee vote signals that Democrats plan to proceed with that strategy, although it does not finalize linking the two bills. The Veterans and Legal Affairs Committee, which is working on LePage’s hospital payback bill, will decide later this week if it agrees to combine the two measures.

The Medicaid expansion proposal, sponsored by Rep. Linda Sanborn, D-Gorham, has been debated in committee for weeks, with Democrats supporting Maine’s participation in the voluntary expansion of the program through the federal Affordable Care Act.

Republicans, along with Gov. Paul LePage, have resisted those efforts, saying the federal government could not make assurances that it will continue to pay the bulk of the health care costs for the expanded population after the initial subsidy period.

Republicans rejected tying the Medicaid expansion with hospital debt payback plan, saying the two issues have different timelines with different consequences.

“Why put the two bills together?” said Rep. Kenneth Fredette, R-Newport. “If Medicaid expansion is such a popular idea then it deserves an up-or-down vote on its own merits. We’ve come to the point where we have unanimous consent that paying the hospitals is the right thing to do. Why are we tying a very popular idea to a very controversial issue?”

Democrats, however, say linking the two issues is good for hospitals because expanding Medicaid will reduce charity care associated with emergency room visits for the uninsured.

The Maine Hospital Association supports Medicaid expansion, but has rejected Democrats’ plan to link to the proposal with LePage’s debt plan.

The association’s lobbyist, Jeffrey Austin, said Wednesday that Medicaid expansion would be a “big win” for the hospitals, but that combining the two bills risks a veto by LePage and jeopardizes the debt payment.

“We expect strong resistance from the second floor (the governor’s office) if these two issues are linked,” Austin said.

Democrats, however, believe tying the two proposals together is the only way to get LePage to agree to Medicaid expansion. The governor has expressed some willingness to explore the issue, but he is getting pressure from within his party to reject expansion.

House Speaker Rep. Mark Eves, D-North Berwick, has made Medicaid expansion his legislative priority, saying that expanding health insurance for low-income Mainers is the right thing to do “financially and morally.”

The Medicaid expansion would cover “able-bodied” parents, and adults who have no children and earn as much as 133 percent of the federal poverty level — just over $20,500 a year for a two-person household. Estimates vary, but advocates say participating in expansion would extend coverage for about 60,000 Mainers. It would also allow more than 10,000 residents currently receiving health care coverage to keep it come Jan 1, 2014. That same group of people are expected to lose access to MaineCare because of eligibility changes the Legislature approved last year to fill a budget gap.

The federal government would pay 100 percent of the cost for the expansion from 2014 to 2016. In subsequent years, reimbursements would decline gradually to 90 percent of the cost, with the state paying the rest.

On Wednesday, Eves said the Health and Human Services Committee will be sending a letter to the Veterans and Legal Affairs Committee recommending Sanborn’s bill to expand Medicaid be considered alongside the liquor contract-hospital repayment bill.

“We’re excited that this is all coming together and it’s happening right now,” he said. “It’s a follow-through on what we’ve been talking about related to paying back our hospitals and making sure that we don’t get back here in the same situation, covering nearly 70,000 Mainers and addressing charity care, a major cost-driver in our health care system.”

Sen. John Tuttle, D-Sanford, the Senate chair of the Veterans and Legal Affairs Committee, told the Portland Press Herald last week that he didn’t support linking Medicaid expansion to the liquor bill. However, Senate President Justin Alfond, D-Portland, said Wednesday that “through many reflections and hearing from many in his district,” Tuttle has changed his mind.

“He fully understands the consequences of not accepting these dollars,” Alfond said. “It means people’s lives are at risk.”

Republican leadership reacted angrily to the committee vote Wednesday, saying Democratic leadership didn’t tell them it was coming.

“This is a complete surprise to us,” Fredette said. “Nobody has called us. There’s been no smoke signals. Nobody let us know this was coming.”

Gov. Paul LePage, in a prepared statement, said he was “astounded by this last-minute political maneuvering to make an end run around the Maine people.” He called on Democratic leaders to take a simple up-or-down vote on his hospital payback plan.

While the committee vote was not announced, advocates on both sides have been increasingly active on the issue in recent days.

Republicans and LePage’s political organization, Maine People Before Politics, recently released statements and a commissioned poll that reaffirmed their position on Medicaid.

On Wednesday, the group Cover Maine Now!, a coalition of health care and progressive groups supporting Medicaid expansion, also released a poll designed to show increasing Medicaid eligibility was popular.

( The headline on this story was initially incorrect. This is a corrected version.)

State House Bureau reporter Michael Shepherd contributed to this report.

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

smistler@mainetoday.com