- Associated Press - Tuesday, February 25, 2014

AUGUSTA, Maine (AP) - Maine would expand Medicaid under the federal health care overhaul while also implementing other significant changes to the program, under a bill laid out Tuesday by two Republican lawmakers who hope to garner the support of more of their GOP colleagues to override the objections of Republican Gov. Paul LePage.

The proposal, crafted by Assistant Senate Republican Leader Roger Katz of Augusta and Sen. Thomas Saviello of Wilton, represents a potential breakthrough in lawmakers’ attempt to pass a bill to expand Medicaid to roughly 70,000 Mainers under the federal health care law. But it also faces significant hurdles.

The attempt at a compromise includes provisions that Republicans have long wanted, like attempting to curb costs in the Medicaid program and to eliminate a waiting list for some patients with the goal of getting more GOP lawmakers on board while at the same time not losing votes from Democrats who may be weary of other parts of the bill, Katz said.

“This is a real test for us as of whether divided government can work … We can be like Washington and the result will be we get nothing done,” Katz said. “Or we can each get something of what’s really important to us, hold our nose a little bit about things we’re not crazy about and actually make a change for the better.”

Under a central component of the bill that will likely be the most difficult for Democrats to embrace, the state would implement managed care in the Medicaid program and contract with three or four organizations that would compete for Medicaid recipients and set up provider networks across state, like private insurance companies do.

The managed care plan will provide the state more predictability in how much the program will cost, Katz said. Managed care organizations would be incentivized to control costs by ensuring that their patients get the appropriate preventive care so they don’t need more expensive treatment down the line.

Democratic leaders applauded the compromise bill, which will be considered by the Health and Human Services Committee on Wednesday. Initial votes on the bill in the full Democratic-controlled Senate could come as early as Thursday.

House Speaker Mark Eves of North Berwick, who introduced the original bill to expand Medicaid this session, called it a “step forward.”

“Our priority has always been securing life-saving health care for 70,000 Maine people,” he said in a statement. “While we have been skeptical of managed care programs in the past, we look forward to hearing the details of the Republican proposal. We will want to make sure that the emphasis is on quality treatment; not simply denying care.”

But the expansion faces significant opposition from many Republican lawmakers and LePage, who has vetoed two previous attempts. Both times, Democrats failed to get enough GOP support to override his veto. Senate Republican Leader Michael Thibodeau of Waldo and Republican leaders in the House panned the proposal Tuesday.

LePage spokeswoman Adrienne Bennett said in an email that “liberals are playing politics with the state’s financial future” and pointed to the $750 million debt in unpaid Medicaid costs the state recently paid the hospitals that the administration says was caused by expanding the Medicaid program in the ‘90s.

“We cannot repeat history and expect a different outcome,” she said. “Connecting these two bills is like putting another $750 million bill on the shoulders of Maine taxpayers. Liberal politicians should realize by now that just because they are introducing welfare expansion for the third time, it’s still not fair to struggling Mainer families and it’s still an unaffordable solution.”

Among the other provisions of the bill, the state would also add two new investigators to the Attorney General’s Office to crack down on fraud in the Medicaid program. It also includes several components of the Medicaid expansion bill proposal Katz authored last year, like allowing the state to withdraw from the expansion after three years, when the federal government begins to gradually lower its share of the cost from 100 percent to 90 percent or more.


Follow Alanna Durkin on Twitter at https://www.twitter.com/aedurkin

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