AUGUSTA – With the end of the legislative session closing in, Democratic lawmakers Monday attempted another push to expand Medicaid, the public health insurance program for the poor.

Democrats in the House of Representatives voted 89-51 to give preliminary approval to L.D. 1066, a proposal sponsored by Rep. Linda Sanborn, D-Gorham, that would increase MaineCare, the state’s version of Medicaid, to approximately 60,000 residents through the Affordable Care Act.

It was Democrats’ second attempt to expand one of the key components of the federal health care law, a fight mirrored in other states as the expansion debate has become a front in the political battle over the Affordable Care Act, or Obamacare.

Democrats’ first attempt was linked to Gov. Paul LePage’s plan to pay Maine’s hospitals $186 million in state owed debt. Republicans objected to the combination bill, arguing that Democrats, who are in the majority, jeopardized bipartisan agreement on the hospital payback bill with divisive Medicaid expansion.

Democrats passed the combination bill but it was immediately vetoed by LePage. The same fate appears to await L.D. 1066, although five Republicans voted with the Democratic majority on Monday.

Republicans lawmakers, whose support would be needed to override a veto by the governor, were nearly unanimous in opposing the standalone expansion bill. Several expressed skepticism that the federal government would follow through on its promise to reimburse states for 90 percent of the costs to insure the expansion population after fully funding it between 2014 and 2016.

Republicans argued that the state should stabilize its current Medicaid program before insuring more people. Several referenced the 3,100 mentally disabled Mainers currently on a waiting list to receive coverage.

Some, including House minority leader Rep. Kenneth Fredette, have proposed studying the impacts of expansion before participating.

Sanborn said the state had all the answers it needed. She said expansion was a step toward repairing a “broken” health care system by providing health care to people who can’t currently afford it.

Rep. Richard Malaby, R-Hancock, who said Medicaid encouraged recipients to “over consume and undervalue” insurance during a lengthy May 22 debate on the combination bill, said Monday that expansion advocates offered “a false choice” when arguing that the state should accept the federal funding. Malaby noted that low-income residents would qualify for subsidies to purchase private insurance through the Affordable Care Act. He said the private route was much less risky to Maine than Medicaid expansion.

Malaby questioned the “financial viability” of the Affordable Care Act.

Malaby’s reference to the subsidies available through the health care law have discussed by Republicans in other states.

The Affordable Care Act will require most Americans to purchase health insurance and those that can’t will receive federal subsidies through state-run exchanges, or insurance marketplaces, to help absorb the cost. To qualify for the subsidies, residents would have to earn between 100 and 400 percent of the federal poverty level.

Residents would have to earn below 138 percent of the federal poverty level to qualify for Medicaid expansion. Critics of expansion believe the income threshold is a disincentive for people to take a higher paying job that doesn’t offer health insurance.

Advocates for private insurance subsidized through the exchanges also argue that low income residents would be less susceptible to the so-called “eligibility cliff.”

The federal government has struck deals with some states, including Arkansas, allowing them to use Medicaid expansion dollars to help low income residents purchase private insurance through the exchange, also known as “premium assistance.”

Skeptics say the private insurance route may ultimately be more costly to the federal government. According to the Congressional Budget Office it will cost the federal government $9,000 per person to provide subsidies through the insurance exchanges compared to $6,000 through Medicaid.

Republicans also said Maine would be penalized for expanding Medicaid nearly a decade ago.

The federal government now pays 62 percent to cover about 10,500 Maine adults without children, and would likely increase reimbursement to 100 percent from 2014 to 2016 before gradually dropping to 90 percent, according to the letter from the Center for Medicaid Services.

Maine also would receive 100 percent funding to cover about 50,000 additional childless adults under Medicaid expansion.

Maine already provides Medicaid to about 15,000 non-disabled parents, as defined in the federal health care law. According to the Centers for Medicare and Medicaid Services, the state would continue to receive its current matching rate of 62 percent.

Expansion isn’t expected to add parents, but it would prevent the 15,000 parents from losing coverage on Jan. 1 because of changes enacted by the Legislature last year.

The LePage administration said it would cost the state $31 million in the next two years to pay for all insured, able-bodied parents, a group estimated to number 41,000. Not everyone in that group would be affected by Medicaid expansion, and the Department of Health and Human Services has already budgeted for the population that would.

Democrats, citing those that would lose coverage, said the consequences for not expanding were dire.

Rep. James Campbell, I-Newfield, was frustrated by the Republican resistance to expansion. Campbell, noting that lawmakers receive publicly-funded health insurance, said he was considering putting in a bill that get rid of legislators’ insurance.

“Maybe I should put a bill in and watch all the (voting) lights to see who want to give it (health insurance) up,” Campbell said.

L.D. 1066 will now move the Senate for a vote.

Steve Mistler can be contacted at 620-7016 or at:
smistler@pressherald.com

 

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