AUGUSTA — An early-morning fix Wednesday to the state’s 2015 budget shortfall, which included a way to drastically reduce the numbers on a state waiting list for Medicaid coverage, may have little effect on the ongoing debate about whether Maine should expand MaineCare, its low-income health care program.
Republican Gov. Paul LePage on Wednesday afternoon vetoed the bill that added 70,000 more people to the low-income health care rolls, largely with funding available in the federal Affordable Care Act. The bill, LD 1487, would set up a managed care model for MaineCare, the state’s Medicaid system, that some Republicans say would not be cost-effective in improving health outcomes.
Sponsored by a pair of moderate Senate Republicans, Roger Katz of Augusta and Thomas Saviello of Wilton, the bill passed the House and Senate on simple majority votes of 97-49 and 21-14, respectively.
To overcome a veto, lawmakers need two-thirds of the who voted on the bill to support it. Veto override votes were unlikely to take place until next week as the Legislature moves toward its adjournment date of April 17.
LePage and Republicans repeatedly said they wouldn’t allow a publicly funded health care expansion unless the state eliminated the waiting list for some of the most disabled residents, many of them in nursing home care.
Despite the budget deal Wednesday that not only closes a $30 million shortfall but also funds coverage for most on Maine’s Medicaid waiting lists — a move Republicans hailed — GOP resistance to an overall expansion seems unlikely to soften.
The budget fix, agreed upon in a unanimous vote of the budget-writing Appropriations Committee, would help those with some of the most profound medical needs including about 10 people who face health care costs of up to $100,000 per year, said state Rep. Peggy Rotundo, D-Lewiston.
Rotundo, House chairwoman of the Appropriations Committee, said she was waiting to see how her Republican colleagues reacted in terms of an overall expansion of Medicaid.
“It’s a significant step forward in addressing the needs of this very vulnerable population, as well as addressing the needs of the elderly and frail in our nursing homes,” Rotundo said.
She said both Republicans and Democrats have consistently supported efforts to reduce the wait list, despite political rhetoric to the contrary.
The deal also increases Medicaid reimbursement rates for nursing homes, many of which have been losing money on Medicaid residents in recent years.
House Speaker Mark Eves, D-North Berwick, said he hoped elimination of the waiting list would sway Republicans to join Democrats in overriding LePage’s veto of the Medicaid expansion bill.
Eves said the waiting list had been a key stumbling block for Republicans.
“This is one thing that they have been saying loud and clear that needs to be addressed before they consider a Medicaid expansion,” Eves said Wednesday. “It’s been removed; that barrier has been removed, so I would anticipate and expect they would give the bill a second look.”
And while Republicans have suggested the waiting list was paid for with funds saved from a reduction in MaineCare eligibility for some adults with children, an expansion would add those adults back to the rolls, further expanding the state’s costs.
Eves said that wasn’t the case because the funding to expand MaineCare, for the first three years of the expansion, comes from the federal government. Eves said there was some misunderstanding about that and that information the Appropriations Committee received from the Maine Department of Health and Human Services shows those adults could be covered without additional cost.
Still, Republicans said overall problems with implementation of the Affordable Care Act, coupled with the low numbers of healthy young adults who have signed up to buy their own insurance under the federal exchange, meant overall health insurance rates were likely to jump again in Maine.
Rep. Ken Fredette, R-Newport, the House minority leader, said his caucus viewed the waiting list and expansion as distinct issues.
He said it was ultimately a budget problem for Republicans. “The question now of getting these people on the wait list taken care of and the nursing homes does address one issue of funding.”
“But I don’t think it resolves many of the uncertainties that we have seen under the Affordable Care Act both nationally and here in Maine,” Fredette said. “I think that many of those concerns continue to be there about the viability of Medicaid expansion in Maine.”
Fredette said the ACA has been fraught with, “delay after delay after delay.” Republicans have also argued that while the federal government promises to largely fund the expansion, the state would see nearly $800 million in annual costs once the expansion were fully implemented under the ACA.
Democrats have argued not only that the state, because of the large sums it would pull down from the federal government, would save money under the expansion.
They also argue that expansion would provide a much-needed infusion of money for the state’s economy and it would lead to the expansion of health care employment in Maine. Both the Maine Medical Association and the Maine Hospital Association have said they support an expansion.
Eves said the way the budget deal was crafted would save the state money, and expanding Medicaid would add as much as $10 million a year to that savings.
He said the argument that removing the waiting list would involve taking health care away from other sector of Mainers was simply misleading.
“The good news is we don’t have to decide to provide health care services to one group over the other,” Eves said. “We can do both.”
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