Reform Update: Despite governor's staunch opposition, Maine lawmakers continue to push for Medicaid expansion

Although Republican Gov. Paul LePage continues to be a stalwart opponent to expanding Medicaid, providers in Maine are still pushing to make their state the 26th state to do so under the Affordable Care Act. Some Maine lawmakers want to go much further and push the state toward a single-payer system.

LePage, a conservative Republican, cites a new feasibility study—which found that Medicaid expansion could cost the state up to $3.2 billion over the next 10 years—as reason to find other solutions to the state's healthcare access problems.

The report has drawn criticism, but LePage defended it in his weekly radio address as “a road map to save taxpayers money and improve services for the truly needy.”

Last year, Medicaid expansion bills passed the Maine Legislature by sizable majorities—97-51 in the House and 23-12 in the Senate—but a two-thirds majority was needed to override LePage's veto, and the votes were not there to do that. In fact, the measure lost support in the House as the override effort failed by a 95-52 vote.

Now bills have been reintroduced in both the state House and Senate that would expand Medicaid coverage to include Maine residents who are at 133% of the federal poverty level. Among those who spoke in favor of the expansion bills at a recent hearing were representatives of the Maine Medical Association, Maine Hospital Association and eight-hospital MaineHealth, the state's largest healthcare system.

Mark Biscone, CEO of MaineHealth's Waldo County General Hospital in Belfast, testified that his hospital has received 25 calls a week since the end of the year from patients who have either lost their Medicaid coverage or lost coverage for their medications. “It is MaineHealth's expectation that this law will provide affordable coverage to a greater number of our most vulnerable patients,” Biscone told lawmakers.

Jeffrey Austin, Maine Hospital Association vice president of government affairs and communication, said the state's 39 community-governed hospitals need Medicaid expansion to make up for scheduled cuts in Medicare payments. He also cited statistics from the last five years showing how Medicaid spending has remained stable—contrary to what some critics have said.

“One aspect of the debate over expansion that is most frustrating to me is the repetition of a tired shibboleth that Medicaid spending is out-of-control,” Austin testified. “It is most definitely not.”

Dr. Amy Madden, a family physician at the Belgrade (Maine) Regional Health Center who testified on behalf of the 4,000-member Maine Medical Association, argued that the expansion would cover a vulnerable population of Maine residents who are getting inferior care.

“The people who would be covered under this expansion are a lot of people in my community—they build our houses, cut our trees, plow our driveways, provide our firewood—they are working and providing for themselves and their families but have neither employer-based benefits nor the disposable income to purchase health insurance,” Madden testified. “When they get sick, they are at risk of significant financial compromise despite our best efforts to connect them with charity care and reduced fee services. Needless to say, they are not getting the basic preventive care that is provided to those of us who have insurance.”

Lawmakers are scheduled to discuss the bills again Jan. 22.

Meanwhile, bills have also been introduced in the Maine House and Senate to establish a single-payer healthcare system effective in 2017.

At a Jan. 9 hearing, Maine Medical Association Deputy Executive Vice President Andrew MacLean testified that his organization was “neither for nor against” the bill. MacLean noted how the MMA passed a resolution in 2002 that “was a clear statement in opposition to a single-payer approach,” but a 2008 survey found that 52.3% of members preferred a single-payer “Medicare for all” approach to healthcare reform.

“Regarding the views of Maine physicians on a single-payer approach to healthcare reform, I think that physicians' views are evolving with more physicians leaning towards a single-payer approach the more they witness the deficits and frustrations of our current system in their daily work,” MacLean testified.

The association reported in its weekly newsletter that it's resurveying its members on the topic this month.

Maine's neighbor Vermont is already transitioning toward a single-payer plan. In Massachusetts, former CMS administrator Dr. Don Berwick is running for governor and has expressed interest in studying single-payer for his state.

Berwick repeated his intention to do so at a Jan. 16 debate.

“I'm the only candidate who has put single payer on the table in this state. We need to take a look at it,” Berwick said in comments at the debate that were then sent out on his @berwickforMA Twitter account. “Single payer is a route to better care, better health, and a better commonwealth.”

The U.S. Supreme Court has denied the California Medical Association’s request to review its suit seeking to block the state from implementing a 10% provider pay cut for Medi-Cal, the state’s Medicaid program.

“As the rest of the nation looks to California for an example of health reform success, we simply cannot move forward with a 10% prospective cut to the Medi-Cal program while simultaneously adding new patients to the program," CMA President Dr. Richard Thorp said in a news item on the CMA website. “CMA and our stakeholder partners will look toward reforms that will result in real access to care so that health reform is more than an empty promise of an insurance card."

Gov. Jerry Brown recently announced his intention to go forward with the cuts, but to drop a plan to also make them retroactive to June 11.

Follow Andis Robeznieks on Twitter: @MHARobeznieks