Democratic lawmakers Monday unveiled a $10.4 million bill that would partially fund a Medicaid expansion – a topic that Republican Gov. Paul LePage and state Democrats have been fighting about since Mainers overwhelmingly voted in favor of extending benefits to more people last fall.
LePage has been a steadfast opponent of Medicaid expansion, which voters passed by a 59-41 percent margin at referendum in November, but the governor does not have the authority to veto a voter-approved law. However, LePage is arguing with Democrats over implementation and has refused to file paperwork with the federal government that was due last week that would have set the wheels in motion to implement the expansion by July 1.
The bill – which was the subject of a public hearing in Augusta on Monday – is not a full funding of Medicaid expansion. That is expected to cost $30 million to $60 million in state funds in the first full year of implementation, according to estimates by the Legislature’s Office of Fiscal and Program Review, a study funded by the Maine Health Access Foundation and the LePage administration. The LePage administration, unlike the other estimates, predicts huge increases in state spending, of more than $100 million per year in future years.
The state money would capture more than $500 million per year in federal funds to provide health care for about 70,000 low-income Mainers earning up to 138 percent of the federal poverty limit, or $16,753 for a single person.
Thirty-three people testified in favor of the bill Monday, while no one spoke in opposition.
The measure would include $3.8 million in state funds and $6.6 million in federal funds.
A March analysis of scholarly research by the Kaiser Family Foundation, a Washington-based nonprofit, concluded that Medicaid did not ruin state budgets in the states that approved Medicaid expansion, and had a number of positive effects, including reductions in uncompensated care for hospitals and more substantial declines in the uninsured rate.
“Analyses find positive effects of expansion on numerous economic outcomes, despite Medicaid enrollment growth initially exceeding projections in many states. Total (federal and state) Medicaid spending increased following expansion implementation, but research suggests that there were no significant increases in state spending from state funds as a result of the expansion through 2015,” the study concluded, noting an “uptick” in state spending in 2017.
Thirty-three states have approved some form of Medicaid expansion as part of the Affordable Care Act passed under President Obama, and Maine was the last New England state to approve expansion.
The bill heard Monday would immediately fund 103 administrative positions within the Department of Health and Human Services, which Democrats see as a necessary first step to providing benefits under expansion.
“Thousands of Mainers cannot afford to wait any longer for the health care they need to be and stay well,” said state Rep. Drew Gattine, D-Westbrook, the chair of the appropriations and financial affairs committee. “While I’m disappointed that this administration continues to obstruct and ignore deadlines clearly laid out in law, our committee continues to do our work and appropriate the funds when they are necessary. This proposal funds the administrative costs requested and there should no longer be any excuses or delays regarding implementation. Maine people have waited too long for Medicaid expansion already, and there is no rational reason to make them wait any longer.”
Rob Poindexter, a spokesman for House Republicans, said they “will only consider supporting a plan to implement Medicaid expansion if it is done so in a fiscally responsible way. By that, I mean a proposal that does not raise taxes on Mainers or Maine businesses; does not raid the rainy day fund; is not one-time funding or a gimmick. And that proposal must fund expansion at the cost projections set forth by the Department of Health and Human Services, not the cost projections of special interest groups. We still have yet to see a proposal from the Democrats that fits those parameters.”
LePage’s office did not respond to a request for comment Monday.
Some moderate Republicans have joined Democrats in recent years to support efforts in the Legislature to expand Medicaid, but not enough Republicans voted to successfully override vetoes by LePage. After efforts to expand Medicaid stalled in the Legislature, advocacy groups got the measure on the ballot in November.
If the state doesn’t implement expansion as required by law, the LePage administration risks being sued in court by advocacy groups.
“More than 70,000 Mainers are waiting for health care,” Robyn Merrill, co-chair of Mainers for Health Care and the executive director of Maine Equal Justice Partners, a nonprofit advocacy group, said in testimony Monday. “The people of Maine are counting on the Legislature to implement the law they passed. Appropriating funding for the costs of implementing Medicaid expansion is an important step in this process. It is our hope the Legislature will act swiftly.”
Donna Wall, an uninsured Lewiston resident who delivers newspapers overnight so she can care for her adult autistic children during the day, told lawmakers in her testimony that she slipped and broke her ankle this winter delivering papers, and now she has $60,000 in medical debt.
“We are looking forward to having the peace of mind of going to the doctor and taking steps toward better health,” Wall said.
Joe Lawlor can be contacted at 791-6376 or at:
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