AUGUSTA, Maine — For the third time in a week, Democrats in the Legislature prevailed Monday on a vote to link an expansion of Medicaid eligibility in Maine to a plan to repay the state’s Medicaid debt to its 39 hospitals.

After lengthy debate, the Senate voted 20-15 in favor of LD 1546, a bill that proposes repayment of Maine’s hospital debt, a restructuring of the state’s wholesale liquor contract and — after votes initiated by majority Democrats on two legislative committees last week — an expansion of Medicaid eligibility in the state under the Affordable Care Act.

All Senate Democrats and independent Sen. Richard Woodbury of Yarmouth supported the measure. All Republicans opposed it.

During often emotional speeches, Democratic senators asserted that Maine lawmakers have a “moral obligation” to open Medicaid eligibility to uninsured, low-income Mainers under a provision of the federal Affordable Care Act. Many shared stories about constituents who would benefit from gaining eligibility for the federal health care coverage. Others suggested that accepting the federal Medicaid funds would reduce future health care costs.

“It is simple. We are putting people first,” Senate Democratic Leader Seth Goodall of Richmond said in summarizing his party’s position on “the biggest issue of this Legislature.”

Republicans called it a “massive welfare expansion” that would further burden Maine taxpayers at a time when state government “can’t afford the people we have on now.” Some accused Democrats of using “Washington-style politics” to rush the Medicaid expansion through the legislative process, while others warned that the federal government would likely renege on its commitment to fund the expansion.

“Linking two bills together that have nothing to do with one another is just what people complain about when they see it in Washington,” said Senate Assistant Republican Leader Roger Katz of Augusta. “That kind of politics has migrated north.”

Katz and other Republicans said they hadn’t made up their minds about Medicaid expansion, but they opposed including it in LD 1546.

Woodbury, an economist, said he supports Medicaid expansion as a necessary way to eliminate what he called an “eligibility cliff” for people who don’t now qualify for government insurance programs but who can’t afford private coverage. Extending eligibility to people with incomes up to 133 percent of the federal poverty limit, when coupled with federal subsidies to purchase private insurance that will become available as part of the Affordable Care Act on Jan. 1,, 2014, is critical to making national health care reform work, he said.

Republican Gov. Paul LePage, a staunch opponent of the Affordable Care Act, has repeatedly identified using a reworked wholesale liquor contract to repay the state’s $181 million share of an overall $484 million Medicaid debt to Maine’s hospitals as his top priority for this legislative session. After reviewing proposals from the LePage administration and Goodall, the Veterans and Legal Affairs Committee crafted LD 1546, which relies on revenue bonds associated with the reworked wholesale liquor contract to repay the state’s share of the hospital debt, triggering federal matching funds that would pay the balance.

LePage and Republicans in the Legislature have strongly resisted adding Medicaid expansion to the hospital debt repayment plan since Democrats stated their intentions late last month to include Medicaid expansion in the hospital debt and liquor contract legislation. The Health and Human Services Committee and Veterans and Legal Affairs Committee both voted along party lines last week to include Medicaid expansion in LD 1546.

Sen. John Tuttle, D-Sanford, Senate chairman of the Veterans and Legal Affairs Committee, originally expressed skepticism about adding Medicaid expansion to the hospital debt repayment plan. After missing Thursday’s committee vote on LD 1546, he voted with majority Democrats in committee. From the floor Monday, Tuttle said, “Listen to the debate and vote your conscience.”

While LePage has been reluctant to expand Medicaid, Health and Human Services Commissioner Mary Mayhew has begun discussing a potential expansion with federal officials. In March, Mayhew sent Kathleen Sebelius, the U.S. health and human services secretary, a letter requesting the federal government cover 100 percent of Maine’s expansion costs for 10 years.

Under the federal health care reform law, the federal government covers 100 percent of costs for newly eligible Medicaid recipients for three years. That 100 percent rate gradually drops to 90 percent by 2020, when the state would make up the rest. Proponents of the expansion say it would cover almost 70,000 Mainers.

In Maine, about 50,000 adults without children would gain Medicaid coverage if the state opts to expand, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. If the state chooses not to expand, about 25,000 childless adults and parents would lose their Medicaid coverage on Jan. 1, 2014.

Parliamentary maneuvers Monday by Republicans in the Senate to delay debate on the bill, then send it back to the committee, failed on party-line votes.

After debate opened, Lisbon Falls Sen. Garrett Mason, the lead Republican on the Veterans and Legal Affairs Committee, railed against Democratic legislative leaders for last week’s addition of language linking Medicaid expansion to the hospital debt repayment bill. Mason lambasted that linkage as “backroom, Pelosi-style Washington politics.”

Mason praised the VLA Committee for striving to “take politics out of the mess,” noting that committee members voted unanimously during a straw vote Wednesday on details of renegotiating the state’s wholesale liquor contract and a bonding mechanism to repay the hospital debt. But then Democrats “dropped a nuke” on the committee’s bipartisan agreement by “ramming through a massive welfare expansion,” he said.

Mason ended his speech with a call for the Senate to adjourn. It was defeated by another 20-15 vote.

Democrats tried to rebuff GOP attempts to portray Medicaid as a welfare program.

“To be absolutely clear, medical insurance is not welfare,” said Sen. Geoff Gratwick, D-Bangor, who is a doctor. “From my perspective as a physician, voting against this bill is a vote to cripple Maine, both literally and figuratively.”

The bill will move to the House, where similar partisan debates can be expected.

House Republican Leader Kenneth Fredette of Newport, who last week proposed an amendment that would separate Medicaid expansion from the bill to repay Medicaid debt to Maine’s hospitals, introduced a second amendment calling for creation of a study group to explore the implications of expanding Medicaid.

“This amendment is a good-faith effort to study the issue of Medicaid expansion,” Fredette said in a prepared statement. “Republicans know that expansion is not ‘free,’ and we are committed to preventing MaineCare from continuing to take an ever-bigger slice of the budget pie, eroding our ability to fund our schools, infrastructure, first responders, and other critical government services.”

Additional House and Senate votes are required before the bill would go to LePage, who would likely veto it in its current form, according to Republican lawmakers.

When asked Friday if he would veto the bill, LePage told WGME, “You got it. As soon as it hits my desk, it’s gone. These people! I’ve been around for 2½ years, what’s wrong with them? There is no way — no way — you’ll see my signature on Medicaid expansion at this time.”

Sen. Patrick Flood, R-Winthrop, who sponsored the bill that laid out LePage’s original plan to use a reworked state wholesale liquor contract to repay the hospital debt, urged his colleagues to do everything possible to save those two core elements of the bill.

Meanwhile, the Cover Maine Now! coalition held a news conference Monday morning at the State House to announce that it would present almost 3,000 petitions supporting expansion to lawmakers. Speakers at the event included Sagadahoc County Sheriff Joel Merry and representatives of AARP, the Maine Medical Association and Maine Equal Justice Partners.

“It is important to emphasize that these are federal dollars already set aside for the state of Maine to expand health care and if we are not ready to accept those funds in 2014, they go away.” said Rich Livingston, state president of AARP Maine.

While the Maine Hospital Association supports both proposals, the group has opposed uniting them in the same bill. Jeff Austin, the association’s vice president of government relations, said it’s a simple calculation given the near universal support for repaying Maine’s hospital debt and a lower level of support for expanding Medicaid.

“Why would we want to reduce the chances of the first [hospital debt] by tying the second bill to it?” he said. “The hospital debt is for services rendered. We provided services to the T we were supposed to under Maine’s policies. We met our obligations under the law to get paid. No further conditions, attachments should be placed on it.”