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Medicaid Expansion Proponents Make Their Case to Maine Lawmakers - Again

AUGUSTA, Maine - Maine's Health and Human Services Committee is considering several bills that would expand Medicaid coverage under the Affordable Care Act. From flat-out expansion, to various compromises, to putting the issue to referendum, they're the latest attempts in a now-annual battle to extend insurance coverage to about 20,000 low-income Mainers.

The idea behind these bills is to close what's known as the coverage gap. The Affordable Care Act was written to expand Medicaid coverage across the country, but a 2012 Supreme Court ruling allowed states to opt out. In non-expansion states like Maine, some low-income individuals now earn too much to qualify for Medicaid, but too little to qualify for subsidies to purchase Marketplace insurance plans.

If Maine closes that coverage gap and expands Medicaid, the federal government will reimburse at 100 percent through 2016. "Despite the fact that we have let two years slip away without expanding, the benefits remain just as pertinent, just as powerful, just as justified today, and some would say, more so," said Democratic Rep. Linda Sanborn, of Gorham, at a public hearing Thursday.

Sanborn said the federal injection of money would fuel the state economy, and expanding health coverage would lower overall health costs, not to mention provide needed healthcare. Sanborn points out that 26 other states have expanded Medicaid. "For those concerned about being an outliar, Maine is now in that category, and is the only state in the Northeast that does not help the working poor obtain coverage."

Two senators, including Republican Tom Saviello, proposed concept bills to allow lawmakers to tailor how Maine could expand Medicaid. Saviello says Maine should create a compromise plan modeled after other states, such as Tennessee or Wyoming. Those state plans require newly-eligible Medicaid recipients to pay for a portion of their insurance.  "I ask you to look for the best way to do this. We have a great opportunity at hand,"  Saviello said.

Proponents of expansion ranged from uninsured Mainers, to a sheriff lamenting the need for coverage for mental health and substance abuse services, to providers, like Dr. Amy Madden of Belgrade. She recounted the experience of a middle-aged patient who struggled to manage his diabetes, high blood pressure, and high cholesterol without insurance. Madden says the man recently had a heart attack and had to leave his job. The irony, she says, is that his health is now so poor he qualifies for disability coverage.

"So instead of providing health insurance initially to allow for comprehensive and continuous care, we instead allowed his health to spiral into a life-threatening situation, where the care was more expensive, when it was delivered through the charity of hospitals and other caregivers, and where his health status is now deemed disabled," Madden said.

Proponents also cited studies that support Medicaid expansion, such as a recent report from New York consulting firm Manatt Health Solutions that found Maine would save $26 million in 2016 if it expanded Medicaid.

But the LePage administration is not swayed by that study, and is instead pointing to a recent report that evaluated enrollment numbers in states that expanded Medicaid.
"And what we found was that states were dramatically over projections, just within the first year," said Tarren Bragdon. Bragdon is CEO of the Foundation for Government Accountability, which produced the report.

"What it means is that states are going to be on the hook for a lot more money in funding Medicaid expansion than what they first projected," Bragdon said. "And that means taxes will either have to go up, or money will have to be redirected from other populations that receive Medicaid benefits, or other areas of the state budget."

After 2016, the federal government will gradually ratchet down its reimbursement rate from 100 percent to 90 percent by 2020. Gov. LePage has vetoed past attempts at Medicaid expansion, saying it's shortsighted to expect that federal funds will always be available. LePage has also pointed out that Maine's previous Medicaid expansion under former Democratic Gov. John Baldacci failed to live up to promises that it would reduce costs.

As if anticipating another stalemate on the issue in the Legislature this year, one lawmaker, Democratic Rep. Mick Devin, has submitted a bill that that would put the decision in voters' hands, through a statewide referendum.