AUGUSTA, Maine — All eyes are on Republican Gov. Paul LePage after the state Senate on Friday granted final passage to a bill that would expand the state’s Medicaid program to roughly 70,000 low-income Mainers under the auspices of the federal Affordable Care Act.
The Senate voted without a roll call or debate to enact the measure, following the House’s enactment on March 20.
The bill now goes to LePage, who has 10 days to veto the bill or let it become law. Support in both chambers of the Legislature has so far not been strong enough to reach the two-thirds threshold necessary to override LePage’s veto.
Though the governor has pledged his veto, action on the bill is unlikely until next week. LePage was off on personal leave Friday and his spokeswoman, Adrienne Bennett, said he would not return until early next week.
Bennett would not disclose the governor’s location, saying his personal time is his own, but LePage has taken a Jamaican vacation this time every year since he was inaugurated, and lawmakers speculated he was in the Caribbean once again.
Medicaid expansion has dominated debate in the State House for the entirety of the 126th Legislature. Last year, LePage vetoed two expansion efforts passed by majority Democrats.
The expansion was a linchpin in President Barack Obama’s landmark 2010 health care law, providing state-funded health insurance to anyone who make less than 138 percent of the federal poverty level and subsidized private health insurance plans to anyone making between 138 percent and 400 percent of the federal poverty level.
But the U.S. Supreme Court in 2012 struck down the provision of the law requiring Medicaid expansion, leaving the decision up to each state.
Each side in the debate, which has fallen mostly along partisan lines, has brought to the table its own studies, reports and predictions for how expansion will affect the state.
Democrats have cast the expansion as a health and economic boon, arguing it will provide life-saving health care to Maine’s most vulnerable and save the state $690 million over 10 years, according to a Kaiser Foundation study.
Republicans have argued that Maine can little afford to expand a MaineCare program they say has crowded out spending on education and other state programs. MaineCare represents 25 percent of the state’s general fund spending. Republicans also have cited a controversial report by the Rhode Island-based Alexander Group that predicts an $807 million cost to the state over 10 years.
Despite the references to different numbers and analyses, many lawmakers have conceded that support or opposition of the bill is as ideological as it is pragmatic.
The bill approved by the Legislature was crafted by moderate Republican Sens. Roger Katz of Augusta and Tom Saviello of Wilton as a compromise, designed to bring more Republicans on board.
It combines Medicaid expansion with a plan to mandate big savings by outsourcing the publicly funded health insurance program to managed care organizations.
On paper, the bill addresses many of the concerns Republican opponents of expansion have raised for two years: The expansion lasts only as long as the federal government pays for nearly 100 percent of the cost, and it would require a vote of the Legislature to continue beyond that. It also includes an automatic opt-out if federal funding drops below promised levels. The Legislature’s nonpartisan budget analysts say the cost of the proposal is minimal.
It also uses built-in savings to clear out a waiting list of Medicaid recipients awaiting in-home and community services, which opponents have said need to be addressed before the program is expanded to include all of Maine’s poorest residents.
Still, the bill has struggled to gain Republican support. In the Senate, Katz and Saviello have been the only members of their caucus to support the bill. Even Sen. Patrick Flood, R-Winthrop, who voted for Medicaid expansion last year, opposed the measure.
If LePage vetoes the bill and the Legislature upholds his veto, there are two other potential vehicles by which Democrats could attempt to resurrect Medicaid expansion — bills by Senate Majority Leader Troy Jackson, D-Allagash, and House Speaker Mark Eves, D-North Berwick.
Jackson said Friday that he is keeping the details of his bill close to his vest, but intends to run it through the Senate if the Katz-Saviello plan is killed.
Follow Mario Moretto on Twitter at @riocarmine.