AUGUSTA — A compromise bill to expand the public health insurance program for the poor passed the House Wednesday, but failed to garner to significant support from Republicans who have been urged by Gov. Paul LePage to reject participating in a key component of the federal health care law.

The House of Representatives voted 97-51 to approve an amended version of L.D. 1066, a proposal that supporters say will provide health insurance to more than 60,000 Mainers through MaineCare, the state’s Medicaid program.

The amended bill is identical to the proposal that passed the Senate 23-12 last week. Three Republican senators supported the measure following an amendment by Sen. Roger Katz, R-Augusta, the assistant minority leader, that was designed to address Republicans’ concerns with the Medicaid expansion through the Affordable Care Act.

Six House Republicans supported the amended bill on Wednesday. Five Republicans voted for the original version of L.D. 1066 last week. Democrats, who control the Legislature, are still hopeful that Republicans will override an almost certain veto by LePage.

“We were able to come together with Republicans to get a good deal for Maine,” said Rep. Linda Sanborn, D-Gorham, the bill’s lead sponsor. “We can’t pass up this deal. If we don’t accept this money, Maine people will lose health care while other states accept these dollars.”

Republican opposition remains sturdy. In previous debates Republicans have said that expanding Medicaid is risky because the state had no assurances that the federal government would follow through on its promise to continue funding the expansion population at 90 percent after fully funding it for the first three years.

The Katz amendment is designed to address that issue by including a “hard sunset” that would end coverage after the 100 percent period ends unless the Legislature authorizes it to continue.

On Wednesday Republican opponents moved a different issue to the center of their opposition: A waiting list of severely disabled recipients who qualify for Medicaid services.

The waiting list is also the subject of a class action lawsuit filed against the LePage administration earlier this year.

During Wednesday’s floor debate Republican opponents said they were unwilling to participate in Medicaid expansion until lawmakers first dealt with the waiting list.

Rep. Deborah Sanderson, R-Chelsea, attempted to amend the bill to include a provision that would provide Medicaid to severely disabled Mainers currently on a waiting list to receive MaineCare.

Sanderson said supporters of Medicaid expansion had been “derelict in their duty” to neglect those on the waiting list. She said the individuals waiting to receive care had been “shoved into the shadows.”

The bipartisan budget compromise devotes approximately $10.4 million to extend services to those residents on the waiting list. Rep. Jeff McCabe, D-Skowhegan, the assistant majority leaders, said the budget doesn’t go far enough. However, the language in Sanderson’s amendment, he said, conflicted with L.D. 1066, making the bill unpassable.

As proposed, Sanderson’s amendment would cost $75 million.

It was defeated Wednesday, 88-61.

The waiting list is also at the center of a class action lawsuit filed by 18 eligible recipients and their guardians against the LePage administration. The lawsuit, filed in January, alleged that the administration and the Department of Health and Human Services violated federal provisions of Medicaid that mandated the state to provide Medicaid to physically and mentally disabled residents that currently qualify for it.

According to court documents, there were 493 residents with intellectual disabilities and autism on a waiting list for MaineCare and another 830 who qualified for home and community-based care. Maine Superior Court Judge Michaela Murphy ruled May 28 that the state was obligated to provide Medicaid to those residents.

It’s not clear if the compromise expansion will gather additional momentum. With the Legislature’s June 19 statutory adjournment fast approaching and big-ticket bills still outstanding, the bill appears to be the Democratic-controlled Legislature’s last chance to expand Medicaid through the Affordable Care Act this session.

Medicaid expansion would extend coverage to adults without children who earn as much as $20,500 a year. Under the amended bill, eligibility would expire after three years, when federal reimbursements for the program are scheduled to decline from 100 percent to 90 percent unless the Legislature takes additional action.

In addition to the “sunset” provision, Katz’s amendment requires an outside auditor to assess the broader financial effects of the expansion and increased co-payments for recipients.

The amendment would require the federal government to confirm that Maine will receive the promised 100 percent federal reimbursement for childless adults who enroll in the program in the first three years of expansion, as prescribed in the Affordable Care Act.

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

Republicans argued that the sunset made a bad bill worse. Some said lawmakers wouldn’t be able to muster the political courage to eliminate health care coverage for people once they had provided it, even if the program proved costly.

Republicans open to expansion have been under mounting pressure to oppose it. Opponents have circulated a list of Republican lawmakers contemplating voting for expansion. That list includes the lawmakers’ phone numbers and a message urging them to reject Medicaid expansion.

The lobbying effort has produced mixed results. Two Republican co-sponsors of L.D. 1066, Sens. Brian Langley, of Ellsworth, and Rodney Whittemore, of Skowhegan, voted against the compromise bill in the Senate last week.

Others have said they’ll continue to support expansion.

“I have no moral certainty that this is the right thing to do,” Katz said last week. “But I have the belief it’s the best I can do for my state.”

L.D. 1066 requires an additional vote in the Senate before going to LePage’s desk.

Steve Mistler – 620-7016
[email protected]

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