AUGUSTA — Democrats who have championed an expansion of Medicaid under the federal Affordable Care Act have one legislative avenue left this year to pass it into law.
Ironically, the last chance this year to enact one of the Democrats’ top priorities hinges on a bill proposed by the Republican leader in the Maine House.
Democratic leaders are weighing whether to give life to a bill that would appoint a study commission to spend the summer and fall determining how much it would cost Maine to expand Medicaid through the federal health care reform law, looking at how the state can contain growth in Medicaid costs, and exploring Medicaid expansion options involving private insurance coverage.
House Speaker Mark Eves said he plans a meeting this week with Rep. Kenneth Fredette of Newport, the House Republican leader, to discuss the prospect of forming a Medicaid expansion study commission. Eves said Democratic leaders also plan to submit emergency legislation in January that lawmakers would take up when they return to Augusta for another legislative session.
“We’re certainly always willing to sit down and work toward a compromise to ensure 70,000 Mainers have health insurance,” Eves said Monday. “It’s going to be something we continue to fight for.”
Fredette floated the study group proposal last month, suggesting the group should look into spending federal Medicaid dollars to purchase commercial health insurance for low-income residents who would otherwise qualify for traditional Medicaid coverage. Some additional commercial coverage options will become available later this year through the federal health law’s insurance exchanges.
The study group was also meant to take the pressure off lawmakers to decide on a major issue in the waning weeks of the legislative session, Fredette said at the time.
Fredette said Monday he still supports the idea, although the Legislature has taken up two bills dealing with Medicaid expansion over the past two months that have been opposed by most Republicans and vetoed by Gov. Paul LePage.
“I’ve said the issue all along is that there hasn’t been really an open conversation with Republicans and the executive branch on how best Medicaid expansion can be done in Maine,” Fredette said. “We were sort of presented with a take-it-or-leave-it proposal.”
Democrats in May called Fredette’s study group proposal a stall tactic by Republicans who oppose expanding Medicaid. Eves on Monday said he needs some assurances before he supports a study group bill.
“I think we have to determine whether we have a genuine partner here that is, at the end of it, at the outcome, we agree on the goal of accepting these federal dollars” for health insurance coverage, Eves said.
Expanding the state’s Medicaid program would provide coverage for about 50,000 adults without children who earn up to 133 percent of the federal poverty level, or $20,628 for a two-person household. The expansion also would prevent about 25,000 parents and childless adults from losing their Medicaid coverage starting Jan. 1, 2014.
Under the Affordable Care Act, the federal government would pay 100 percent of costs for new Medicaid recipients for three years starting Jan. 1, 2014. That 100 percent rate would gradually fall to 90 percent by 2020 and the state would have to make up the remaining share. The federal government currently pays about 62 percent of costs to cover those in Maine who receive Medicaid coverage.
“This is something that is too important to slow down on,” Eves said. “It’s the right thing to do. I think that when the Republicans go back home to their districts, they’re going to hear from their constituents, who will ask why they didn’t support making sure 70,000 Mainers got health care.”
Using Medicaid funds to provide low-income residents with commercial health insurance is an option that could prove more appealing to Republicans who have been hesitant to expand a public health insurance program. Republicans have also objected procedurally to Democratic attempts to pass an expansion of Medicaid this spring, including through linking the expansion with repayment of Maine’s $484 million hospital debt.
Fredette said the study group bill offers the opportunity to get the process right.
“This, to me, would be an example where process doomed the substance,” Fredette said. “Let’s get the process right so we can get to the question of the substance, because we’ve never gotten to the question of the substance.”
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