Hospital muscle could override LePage veto

Legislative preview: Medicaid expansion, round 2
By LANCE TAPLEY  |  January 10, 2014


crucial legislators who could help decide Medicaid issue 


The immediate and by far the biggest item on the agenda when the second regular session of the 126th Legislature convenes on January 8 will be whether to accept federal Affordable Care Act (Obamacare) funds extending Medicaid, the federal-state health insurance for the poor, to about 70,000 Mainers.

This extension would include 24,000 people who began to be eliminated from the program on January 1 — 10,000 adults without children were dropped on New Year’s Day.

Does the issue sound familiar? That’s because this movie has played before at the State House multiplex. In the spring the Democratic-controlled Legislature passed a bill accepting the money, but the Dems came up several votes short in their attempt to override Republican Governor Paul LePage’s veto. (See “A Legislative Decision: 86 Mainers to Die by Election Day 2014,” by Lance Tapley, June 28, 2013.)

Since then, Democratic leaders and their progressive allies such as the Maine People’s Alliance and Maine Equal Justice Partners have worked hard to make sure a second expected override effort succeeds. They have made progress — with a powerful ally, the state’s hospitals.

But Republicans also have been at work — firming up opposition, which is based on philosophical resistance to expanding “welfare,” plus fears of the state being stuck with a big bill for the additional Mainers covered. Obamacare promises, however, to pay 100 percent of all costs for three years, then reduce federal payments to 90 percent by 2020. The expanded Medica id (a/k/a MaineCare) would cover those who make up to 138 percent of the poverty level — less than $15,900 for an individual.

The Medicaid expansion is “absolutely” the most important issue in the session, says Justin Alfond, Senate president. The debate on it, he adds, will take place “right away.” There’s “a great sense of urgency” about the issue, agrees Mark Eves, House speaker.

Both Alfond and Eves — interviewed separately in their offices — calculate that the state, by not taking the money, is forgoing $700,000 a day from the feds beginning January 1. (That’s $5.6 million by the date the session opens for business.) Besides the moral argument of the need to help people obtain health care, they emphasize the value of that money pumped into the leaky Maine economy.

They’re guardedly upbeat. “I think we’re going to be successful,” Alfond says. A major reason, he adds, is that the state’s hospitals are putting pressure on their local GOP legislators. Still, Eves cautions, the vote will “continue to
be close.”

In the last go-around, the Maine Hospital Association, while officially in favor of the Medicaid expansion, largely sat out the debate. As Eves puts it, “they made a choice where they’d put their efforts.” They lobbied for legislation that resulted in the state paying several hundred million dollars due them for past Medicaid expenses — one of LePage’s priorities.

But now they’re “fully on board,” Eves says of the hospitals. And they have a big incentive: under Obamacare, hospital and doctor Medicare reimbursements will be cut, and the extra Medicaid money will help compensate for the cuts. (Advocates for the Medicaid extension are eager to point out that people insured under Medicare — largely, the 65-and-older population — will not see benefits cut.)

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