Republicans in the Maine Legislature have given excuse after excuse for opposing a bill to both expand Medicaid to about 60,000 people and pay the state’s $186 million share of debt to 39 hospitals. After Gov. Paul LePage on Thursday vetoed the bill, LD 1546, and with not enough Republican support to override the veto, hospital CEOs should be indignant. But they should not be as outraged as Maine residents, particularly those whose quality of life — and even life expectancy — could improve with access to health care.
Maine must pay back the hospitals, and it must expand Medicaid. To stall or block either imperative is to deny the obvious at the expense of the poor and the sick. The state has delayed making a decision about expansion since June 28, 2012 — when the U.S. Supreme Court ruled the Affordable Care Act constitutional and the Medicaid expansion optional. LePage has wasted the state’s time by making preposterous requests of the federal government to pay for 10 years of expansion and to grant the state a “ global waiver” to change how it delivers Medicaid services.
Legislative Republicans have continued to block Medicaid expansion, while saying they are not opposed to the concept “in principle.” Even though the Affordable Care Act mandates the federal government to pay states the full cost of expansion for three years and then ratchet down to no less than 90 percent thereafter, they have opposed this major policy change based in part on doubts federal officials will hold their promise. If they seriously are worried the federal government won’t stick to the law, they could have amended current legislation to return eligibility levels to 2013 standards in the event federal funding did decrease. Or they could remember Maine can drop out of the expansion program later, per the Centers for Medicare & Medicaid Services’ rules.
Republican lawmakers walked into the trap Democrats set to link Medicaid expansion and the hospital payback plan and then used the combination bill as an excuse to vote against it. They complained they were “coerced,” arguing that the two measures should be decided separately. Mainers, however, recognize that the substance of the policies here is more important than the process. While there’s no doubt the combination bill is a political tactic meant to improve the odds of Medicaid expansion occurring, no one should be under the impression Republicans were going to wholeheartedly back a bill that solely addressed Medicaid expansion.
Democrats agreed, rightly, to support the Republicans’ proposal to use the revenue from the state’s future liquor business to pay off the hospital debt. What ground has the GOP ceded? On Thursday, House Republican leader Ken Fredette, R-Newport, submitted a bill to establish a study group on Medicaid expansion, describing it as a “compromise.” While the goals of the proposed group appear benign — such as to study the costs associated with expansion and ways to limit the growth of Medicaid in Maine — in reality, it’s another delay. The Maine Department of Health and Human Services could and should have worked with the federal government months ago to complete an actuarial analysis.
At the same time they have called for a study, Republicans have argued Medicaid expansion would add costs to an already expensive program. It’s true Maine will likely pay more in the long-term. The fiscal note attached to LD 1546 estimates the state would pay $8.9 million in 2016-17 for expanding health care to 55,545 childless adults with incomes up to 138 percent of the federal poverty line. Meanwhile, the federal government would contribute $348.9 million that year.
Consider the numbers in context: The budget for Maine’s Medicaid program in 2013 is $2.45 billion, excluding administrative costs, with $648 million coming from the state’s general fund. Consider also that the Medicaid program has shown results. Opponents point out that Medicaid coverage does not seem to have an effect on emergency room use, but what they don’t say is that it has been documented to increase health care use, increase the use of recommended preventive care, reduce financial strain on enrollees and improve reported physical and mental health, according to a study by the Harvard School of Public Health, Massachusetts Institute of Technology, the National Bureau of Economic Research and Providence Health & Services. Also, expanding Medicaid is not an excuse to avoid continuing work to find efficiencies within the program. Indeed, that work is ongoing at DHHS.
Sadly, we are not surprised the governor vetoed LD 1546. But we expected more from Republican legislators who interact more closely with the general public, know the struggles of their neighbors and tout their tax-reform package of the 125th Legislature that reduced income taxes for 70,000 low-income people — some of the same residents who would benefit from Medicaid expansion. Four Republican senators and eight Republican representatives — if Rep. Stanley Short, D-Pittsfield, changes his vote — are all that it would take to override a LePage veto.
Maine’s opportunity to provide coverage for its vulnerable populations is fast disappearing. The state has flexibility over when it starts or ends expansion, but the federal match rates are tied by law to calendar years. Maine will only receive 100 percent federal support in 2014, 2015 and 2016. Do Republican lawmakers really want to be remembered as the politicians who prevented passage of a bill to give health insurance to the poor?