May 23, 2013

No deal in sight to rescue Maine health bill

Gov. LePage looks poised to veto the popular hospital payback plan in order to block Medicaid expansion.

By Michael Shepherd mshepherd@mainetoday.com
State House Bureau

AUGUSTA — Gov. Paul Le-Page's office hinted Wednesday that he will veto a bill backed by Democrats to link his hospital debt repayment plan to expansion of the health care program for low-income Mainers.

But Democratic leaders are pressing on with the bill, which the House passed Wednesday, 87-56, and the Senate is poised to enact Thursday.

When asked by reporters what they will do if LePage vetoes the bill, they didn't outline a backup plan.

"We are focused on making the case to the last minute with Republicans and the governor about what a benefit this is to the people of Maine and why they should follow through with it," said House Speaker Mark Eves, D-North Berwick.

Republicans, including the governor, vehemently oppose linking the issues: expanding MaineCare, the state's Medicaid program, to about 60,000 Mainers under the federal Affordable Care Act while paying the state's debt to its 39 hospitals with money from its next wholesale liquor contract.

"There's no disputing the governor's position on tying welfare expansion to this debt," said Adrienne Bennett, LePage's spokeswoman. "I don't think it's any stretch of the imagination to think that he would veto the bill."

If LePage vetoes the bill and Democrats don't separate the hospital repayment from Medicaid expansion, Republicans are prepared to uphold LePage's veto and end the legislative session in June without a deal to pay the hospitals, a measure on which both parties agree.

"Either we bifurcate this megabill of theirs or there's a stalemate," said David Sorensen, a spokesman for House Republicans. "We're not going to be held hostage to expanding welfare. It's on the Democrats if they don't want to pass a bill we both agree on."

While repaying hospitals for overdue Medicaid reimbursements was one of LePage's largest campaign promises in 2010, he has long been wary of Medicaid expansion. LePage has engaged the federal government in initial conversations on the topic, but Republicans say more time is needed to negotiate the best possible deal for the state.

LePage has asked the federal government to fund 100 percent of the cost of expansion over 10 years. Eves said that is an unrealistic offer that "showed his insincerity" to negotiate a deal on the issue.

The governor has long chided Democrats for not acting quickly on his hospital repayment plan. Now, they're noting that the Legislature is backing a bill that would pay the hospitals.

"The question that needs to be asked is: Why isn't the governor going to sign this bill?" Eves said. "If the governor follows through on his veto threat, why is the governor not following through on his major legislative initiative this session?"

Democratic leaders say that paying hospitals without addressing health care costs would be irresponsible, especially with the exploding cost of charity care for Maine residents.

But Republicans have noted that Maine's last Medicaid expansion, in the early part of the last decade, didn't reduce charity care, which ballooned from $61 million in 2001 to $196 million in 2011, according to state numbers. Hospitals must provide free care to certain poor Maine residents under state law.

Twenty-one states have agreed to participate in Medicaid expansion. Maine is one of six that haven't decided. Medicaid served 18 percent of Maine's adult population in 2011, according to the Kaiser Family Foundation, making it the third-largest state program.

According to Kaiser, expansion is projected to save Maine $690 million in the next 10 years, with the federal government paying 100 percent of the cost from 2014 to 2016 and 90 percent in subsequent years.

But Republicans have questioned that long-term estimate, saying it could decline and leave Maine to pay the difference. Eves said he's confident in the federal government's record of making payments to the state, saying that argument is "another excuse to delay and deny people health care."

Bennett, LePage's spokeswoman, said she is "baffled" by Democrats' decision to leave the bills linked.

"Democrats have an opportunity to have a robust discussion in the Legislature about welfare expansion and do it in a transparent manner," Bennett said. "They'd get credit for it. Instead, they're taking these two issues and creating a roadblock for themselves on both of them."

Michael Shepherd can be contacted at 370-7652 or at:

mshepherd@mainetoday.com

Twitter: @mikeshepherdme

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