House gives final approval to MaineCare expansion

AUGUSTA, Maine (AP) -- The Democratic-led Maine House gave final approval Wednesday to a retooled plan to expand health coverage to 70,000 low-income people under the federal health care overhaul, though it cuts off the state's participation in the program after three years and raises co-payments for participants.

Lawmakers passed a bill to expand Medicaid, which is administered as MaineCare in the state, by a bipartisan 97-51 vote. But the expansion faces an uncertain future. The measure fell just short of the two-thirds vote necessary to override a veto from Republican Gov. Paul LePage, who opposes the expansion and rejected a previous version of the bill.

The measure approved Wednesday includes significant changes from one already endorsed by both chambers and vetoed by LePage. The House agreed with an amendment brought forward last week by Assistant Republican Leader in the Senate, Roger Katz of Augusta, which would repeal the program on Dec. 31, 2016. The federal government has confirmed it will pay for 100 percent of the cost of expansion until then, but some lawmakers have expressed concern that it won't keep that promise.

Assistant House Majority Leader Jeff McCabe, D-Skowhegan, touted the proposal as a compromise that will give Maine a chance to get out of the program if the costs of the expansion become too burdensome on the state.

"We can get out at any point in time if the federal government does not stay to their word and pay what they say they will pay," he said during the debate.

After 2016, the federal government's share of the cost of expansion tapers off until it reaches 90 percent in 2020.

The bill faces a final vote in the Senate before heading to LePage's desk.

Under the bill, the federal government would also have to confirm that the state will receive a 100 percent compensation rate for childless adults covered under MaineCare, including those covered as of December 2009. People covered under MaineCare would also see larger co-payments to discourage abuse of the program.

Minority Republicans remained critical of the expansion for its potential costs, which they say will ultimately be pushed onto the taxpayers.

"We all want to have people have access to health insurance," said House Republican Leader Kenneth Fredette, of Newport. "But it's a reality in our society today that you can't just have universal health insurance. It's not something we do in this country because we generally can't afford it."

Democrats had originally tied the Medicaid expansion proposal to a bill that would pay back a debt of more than $480 million to the state's hospitals — one of LePage's top legislative priorities. LePage criticized Democrats for linking the two issues, calling it a "quest to force welfare expansion upon the Maine people."

LePage re-introduced the hospital debt payment plan, which renegotiates the state's liquor-sales contract to bring in money to cover the state's share of the debt. The Senate is expected to take initial votes on that bill Wednesday night.

Democratic leaders said Wednesday that they remained hopeful they would be able to get enough Republicans on board for the expansion to achieve the vote necessary to override the governor's veto.

"We are getting closer and closer," Senate President Justin Alfond, D-Portland, told reporters after the vote in the House. "It's very bipartisan. People are getting more comfortable with expanding health care in Maine and what it will do," he said.

Earlier Wednesday, Republicans sought to attach amendments that would require the state to provide coverage to all adults on waiting lists for MaineCare, a move designed to kill the bill.

LePage and Republican lawmakers say that the state should not consider expanding Medicaid coverage until it addresses the 3,100 elderly and disabled people on waiting lists for coverage.

"If we cannot support the people whose voice I bring to you today, how can we support expansion? We can't," said Rep. Deborah Sanderson, R-Chelsea, who introduced the amendment. "Not without denying service to the neediest. It's that simple."

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