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home : • politics : • government
January 26, 2020

3/5/2014 3:53:00 PM
Eye on Augusta: Medicaid Expansion Clears First Hurdle
by Andy O’Brien

On a straight party-line vote of 7-5, Democratic members of the Health and Human Services Committee endorsed an amended proposal to accept over $300 million in federal funding to provide health care coverage for up to 70,000 low-income Mainers. Democrats are hoping the compromise amendment, sponsored by Assistant Republican Senate Leader Roger Katz (Kennebec) and Sen. Tom Saviello (R-Franklin), will receive enough Republican votes to override an expected veto by Gov. Paul LePage, who remains fervently opposed to Medicaid expansion.

A key piece of the amendment is the requirement to contract with three or four managed care organizations (MCOs) that would accept a set rate to manage Medicaid populations rather than the current "fee-for-service" model. According to Sen. Katz, the state would set up a competitive bidding process and the winning bidders would be responsible for making up any cost overruns. He said that the proposal could save the state budget five percent on MaineCare, the state's Medicaid program. Maine spends one of the largest percentages of its budget on Medicaid in the country, even though costs per recipient rank Maine in the middle of the pack.

"We are heading toward the cliff in this bus and those who criticize the system and say it's taking up a larger and larger portion of our state budget, they are right and it's interfering with our ability to fund other things," said Katz. "This gives us an amazing opportunity to take the best of what 45 other states are doing with at least a portion of their Medicaid populations."

Democrats, who had not supported managed care previously, said that while they were not hot on the idea, they were confident that the amendment included adequate protections that would prevent members from being refused coverage or discharged from plans. Democratic Speaker Mark Eves told the committee that the compromise bill "strikes the right balance between health care coverage for 70,000 Mainers and cost containment."

Most Republicans and the LePage administration remain opposed to Medicaid expansion, even with the Katz amendment. DHHS Commissioner Mary Mayhew told the committee that the managed-care provision is duplicative because the department has already enacted similar measures. Mayhew said she spoke with health care providers and staff who are already making investments locally and would rather have reimbursements go directly to providers.

"Why would you bring in an out-of-state company and pay that company to hire nurse care managers and case managers when we are investing in that staff today in our practices?" Mayhew asked.

Republicans questioned estimates by the Legislature's non-partisan Office of Fiscal and Policy Review that found the proposal would only cost the state $683,520 out of an over $6 billion budget. Rep. Deb Sanderson (R-Chelsea) declared that she didn't believe OFPR's projections of $5.9 million in savings in the first year - the LePage administration estimates it would cost the state $14 million.

"If we're going to pass a bill with the budgetary impact that this one has the potential to make based on potentially false numbers on a document given to us in committee ... then you do so at your own peril," said Sanderson.

Under the Affordable Care Act (ACA) the federal government will provide 100 percent reimbursement for MaineCare, the state's Medicaid program, for three years and then gradually reduce the reimbursement to 90 percent by 2020 for those who fall within the "coverage gap," meaning they are too poor to afford insurance under the ACA. While Republicans claim the expansion will cost the state millions, supporters point to studies such as one by the nonpartisan Kaiser Family Foundation which estimated that Maine could save $690 million in emergency charity care through expansion.

However, supporters of the compromise bill suffered a setback when one of the bill's co-sponsors, Rep. Carol McElwee (R-Caribou), joined her Republican colleagues to vote against the measure after voting for Medicaid expansion twice last year. She said that while she had felt that it was the "ethical thing to do," her district didn't want the bill to pass.

"Caribou is a Republican community and my constituents do not want MaineCare," she said before voting against the measure.

Last year Medcaid expansion failed by three votes. The bill is expected to be taken up by the full Legislature any day now.

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