Medicaid expansion dead this session
Augusta — Democratic Speaker of the House Mark Eves said April 8 the chances of Medicaid expansion becoming law this session are very slim, and on April 9, the governor verified that supposition.
This is the third time the governor has vetoed Medicaid expansion. The Senate was unable to muster the votes to override the veto April 11, and LePage's decision was affirmed 22 to 13. Twenty-four votes were needed to override the veto.
"We're extremely disappointed because we know how important life-saving health care is to people and that's what drives us," Eves said.
An estimated 70,000 Mainers are without health insurance.
But Eves said Democrats will not back down. Health care is an issue that will be talked about until the election, and he believes Congressman Mike Michaud, if elected governor, will make getting Medicaid expansion passed his first priority. "We will stand there with Maine people making sure they have access to health care," he said.
"We know people delay care, and this is about life saving care for people, which is not disputable," said Eves. People who oppose expansion are uncomfortable with it, but it is the reality, he said.
Gov. LePage said Maine cannot afford to expand Medicaid to 100,000 able-bodied adults. "The expansion offered through Obamacare would have a disastrous impact on Maine’s budget, as well as those truly needy individuals, our disabled and elderly, who rely today on the scarce resources in our program. Maine has been down this road before, and we must learn from previous experience. Medicaid spending grew by $1 billion dollars in a decade, hospital bills were not being paid by the state, budgets were broken and thousands of elderly and people with disabilities were forced to wait for critical services," he said in a press release April 9.
The governor also asserts Maine agencies are cannibalized by welfare spending, and that services will cost $2.2 billion in the next two years, even without expansion.
Eves said passing Medicaid expansion will happen, it is just a matter of when, and how much money the state will lose out on. The Federal government proposes funding 100 percent of the cost of implementing expansion until 2016, and will then fund up to 90 percent of costs. Eves said Maine has already lost out on $250 million.
The speaker said it is also important for the economy. He said the state is forgoing nearly $1 million a day, about $89 million total thus far for the state's economy by not accepting federal funding.
The vote in favor of a bill touted as a bipartisan compromise and sponsored by Sens. Richard Katz of Kennebec and Tom Saviello of Wilton, fell short of the two-thirds majority needed to override an expected Gov. LePage veto.
The bill, LD 1487, proposes implementing a managed care system in the MaineCare program.
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 19. Democratic Sen. Ed Mazurek of Rockland voted in favor of the bill.
"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, " Winchenbach said after the vote in March.
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.
Eves said the bill struck the right balance, but that it will be unable to pass because the governor has dug his heels in.
Katz's bill, Eves said, was genuine in effort, and well thought out, but Katz's Republican colleagues had strong opposition to it. "They did not know what they were voting on, they just knew they did not want to expand health care," Eves said of opposition votes.
If Katz's bill is not adopted, Eves said the ship has sailed for Republicans to have their fingerprints on a health care bill. He said the federal law is a good deal.
The bipartisan bill on the table now, 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.
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.
Katz said this system would save $30 million per biennuim.
History of Medicaid expansion
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 Lewiston.
"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.
Courier Publications' reporter Juliette Laaka can be reached at 594-4401 ext. 118 or via email at firstname.lastname@example.org.
594-4401 ext. 118
Juliette primarily covers the cops and courts beat for The Courier-Gazette.
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