Compromise bill to expand MaineCare passes Legislature
Augusta — A Republican sponsored bill to expand low-income health care to 70,000 uninsured Mainers was approved by the Legislature March 18, but the votes are short of the number needed to override the governor's veto.
The bill, LD 1487, sponsored by Republican Sens. Bill Katz of Kennebec, and Tom Saviello of Wilton, proposes implementing a managed care system into the MaineCare program. The bill passed 22 to 13 in the Senate March 12 and passed 97 to 49 in the House March 18.
Five Republican representatives were absent from the vote, according to the roll call.
Local representatives, Independent Jeffrey Evangelos of Friendship, Democrat Joan Welsh of Camden, Democrat Elizabeth Dickerson of Rockland, Democrat Chuck Kruger of Thomaston, and Republican Ellen Winchenbach of Waldoboro voted in favor of the bill March 18.
Democratic Sen. Ed Mazurek of Rockland voted in favor of the bill March 12.
Two-thirds of the governing body are needed to override a veto.
The Senate is one vote shy of that majority. The House vote, 97 to 49, comes to .664, and .667 is needed to override the veto, said Evangelos.
Winchenbach said she still has hope for the bill and is disappointed politics is getting in the way of action.
"I wish it wasn't so partisan, I really think it is a good deal, and we owe it to the Maine people to make it work, " she said after the vote.
As the minority in her caucus in voting in favor of the bill, Winchenbach has had conversations with colleagues about considering approving the expansion, but said many people have their minds made up and are firm on their position.
Managed care would require the Department of Health and Humans Services to contract with health insurance providers or networks to provide care at a set price.
"The fee for service program is spending billions with little concentration on prevention, inadequate accountability and high and frequent cost overruns," Katz said to the Health and Human Services committee during his testimony March 3.
He also stated the bill is not about how many people should or should not be enrolled in the MaineCare program.
Other states have implemented managed care systems with mixed results, he said, adding Maine can learn from the mistakes and build upon the best practices to improve the state's health care system.
The bill would require the Department of Health and Human Services to select three or four plans from nationally accredited providers which would compete for enrollment of MaineCare patients statewide.
The provider would be paid a capitated rate by the state for each enrollee and would manage the care for each patient. Capitated rates take into consideration age, sex and geographic location, as well as employment.
Katz said this system would save $30 million per biennuim.
Although the devil is in the details, he said, the managed care system is designed to ideally improve health outcomes and lower costs. There is a good and bad way this can go, he said. One, the program could deny access to care, and lower reimbursement rates to providers, but it also could provide a more effective way for patients to get care, he said in his testimony. Ensuring the system functions the way it should, is up to the contracts with plan providers, he said.
Evangelos called Katz's bill a compromise. The Speaker of the House, Democrat Mark Eves of North Berwick, also sponsored a bill to expand MaineCare. His bill has been referred to the Health and human Services Committee and has not been voted on yet. It is not clear what the future of the bill will be if Katz's bill is unable to override a veto.
"This is not a Republican idea or a Democratic idea. This is a best practice, good government idea," Katz said of the managed care bill.
Maine did not expand MaineCare, in the last legislative session. Although it passed in the House and Senate, Gov. Paul LePage vetoed the bill.
When the Affordable Care Act was adopted into law, the legislation mandated states to accept federal money for the expansion of Medicaid. The Supreme Court struck this clause from the law, and made the option voluntary for states, said Malory Shaughnessy of Maine Community Health Options in Lewsiton.
"Federal policy is set up in pieces," Shaughnessy said. "The original policy never intended to cover individuals below 100 percent of the poverty line, it was not set up to do that, and the law has not been changed," she said.
When the court made state participation voluntary, that one piece was nixed, leaving a gap of uninsured Americans.
Eligibility of MaineCare comes in two parts. It is based on income, and also a categorical need. Shaughnessy explained a category as an individual having a disability and or having a minor child in the home.
Under this system, a 30-year-old making less than $11,500 a year is not eligible as only their income qualifies them for state aid. This is the individual the Affordable Care Act hoped to cover with the expansion of Medicaid.
Expanding MaineCare would require accepting federal money totaling $3 billion to cover the costs of expansion of the program for three years, until 2016, and would fund up to 90 percent of the costs at the end of that term.
The bill, if passed, expands medical coverage under the MaineCare program to adults 19 to 64 who qualify under federal law with incomes up to 138 percent of the non-farm poverty line.
Evangelos said there is a three year opt-out provision, where states can back out before encountering costs in the event expansion does not work as planned. Also, during the three years of federal funding, the state establishes a savings account to offset the fourth year, and more costs.
LePage said Maine agencies are cannibalized by welfare spending, and that services will cost $2.2 billion in the next two years, even without expansion.
He said in an press release, MaineCare spending is taking funds away from education, law enforcement, economic development and programs to protect natural resources.
If MaineCare is expanded, the program is expected to account for 45 percent of the General Fund revenue, he said.
"We simply cannot keep throwing money at an inadequate welfare program. The state is not meeting the health care needs of vulnerable Mainers, and adding more people to the welfare rolls will only exacerbate the problem, " the governor said. "Expanding welfare a decade ago did not increase access or improve the quality of care, nor did it help uninsured Mainers. Now it is threatening all of the other programs and services Mainers expect from their state government."
Courier Publications' reporter Juliette Laaka can be reached at 594-4401 ext. 118 or via email at email@example.com.