Democrats and a Cover Maine Now coalition of 86 groups supporting the expansion made a case about the human costs of not insuring tens of thousands of people. But, repeating the most common argument heard in Augusta for any reform, they dwelt more on the "economic stimulus to the state," as Sara Gagné-Holmes, who led the coalition, put it, of the extra health-care spending involved. Gagné-Holmes is director of Maine Equal Justice Partners, a group that lobbies for poor people.

For most of the session, Democrats had tried to tie passage of the Medicaid expansion to payment to the state's hospitals of unpaid Medicaid bills. But when LePage vetoed a measure connecting the two issues and that veto was upheld, they quickly joined Republicans in giving the cash to the hospitals. The hospitals got $484 million, the majority of that sum federal funds.

So, after being guaranteed hundreds of millions of dollars from the state and feds, DID THE HOSPITALS MOUNT A FULL-COURT PRESS to ensure that 70,000 low-income Mainers would get health insurance? The hospitals, after all, would get the lion's share of the Medicaid payments.

Answer: Although the Maine Hospital Association officially supported the expansion, the group's lobbyist, Jeffrey Austin, was conspicuously absent from the State House during most of the critical final day of debate. And the association didn't join the Cover Maine Now coalition, even though groups representing doctors and other health-care providers did.

"I feel like they should press a little bit harder," said Democratic Senator Margaret Craven, chairwoman of the Health and Human Services Committee, of the hospitals, commenting before the vote.

Some State House observers thought it was unseemly that the hospitals' lobbying arm at best weakly supported the expansion while, even before being assured of the Medicaid debt payment, they were engaged in a construction binge (a $322-million new MaineGeneral hospital in Augusta is being built, for example) and hospital CEOs are drawing fabulous paychecks (MaineHealth's William Caron collects $1.1 million a year overseeing a nine-hospital system including Portland's MaineMed).

"When they get those overdue hospital payments, they're just going to be floating in money," Wayne Gregersen, who handles employee health benefits at the Jackson Laboratory in Bar Harbor, had told the Bangor Daily News in March, speaking about the state's hospitals.

Austin, the hospital association lobbyist, said he had stopped by the Legislature the morning of the House vote, but he was evasive when asked if he had lobbied legislators on the bill. Some hospital officials called legislators to urge the override, he said. His group didn't join the Cover Maine Now coalition because "we're not generally coalition people."

Hospital boards are frequently composed of the wealthiest and most powerful members of the community. "A lot are Republicans," said a person close to hospital higher-ups. "A lot support LePage and don't want to confront him."

So in the struggle over the Medicaid expansion WHY DID THE DEMOCRATS SO EARLY GIVE UP THEIR SUPPOSED BARGAINING CHIP of paying the hospital debt — when LePage had made that payment his top legislative priority?

The Dems could have waited until the Medicaid expansion issue was settled before paying the hospitals, maintained independent Portland state Representative Ben Chipman, "but they didn't use it as leverage for anything." Another House independent, Jeff Evangelos, snorted that the Democrats were "relying on the good faith" of the governor to allow the expansion to take place after the hospitals were paid.

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  Topics: This Just In , Medicaid, Paul Lepage, MaineCare
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