By Steve Mistler

House Democrats' last-ditch effort to extend health insurance to more than 60,000 low-income Mainers failed in the Legislature on Wednesday, ending, at least for now, one of the more contentious battles of the Legislative session.

The outcome was sealed when a majority of Republicans sided with Gov. Paul LePage, upholding his veto of L.D. 1066, a bill that would have broadened Medicaid, the public insurance program for the poor, through the Affordable Care Act.

The final 95-52 vote in the House was three votes shy of overriding the governor's veto. Four Republicans voted with the Democratic majority to override the veto.

Overturning a veto requires two-thirds of lawmakers present and voting. The final vote followed an frantic afternoon session marked by a flurry of parliamentary and political maneuvers.

The Medicaid expansion debate has been one of the top political battles of the session, with Maine Democrats seeking to join 24 other states pushing to broaden the program and bolster a key component of the federal health care law. Republican resistance has been fierce, although an amended version of L.D. 1066 was crafted by Sen. Roger Katz, the Republican minority leader in the Senate.

The failure to expand Medicaid fail means the state will likely lose at least one year of full federal funding, even in the event of a future agreement to go ahead with expansion.

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Advocates for the law said the outcome showed "partisan politics won out over good public policy."

"We are disappointed that a minority of lawmakers would refuse access to health care for thousands of hardworking Mainers," said Sara Gagne-Holmes, executive director of Maine Equal Justice Partners and a leader of the Cover Maine Now! a coalition of advocates that includes doctors and health organizations. "Because of the actions of Gov. LePage and a handful of lawmakers, nearly 70,000 Mainers will suffer unnecessarily as they are denied access to affordable health care."

The high political stakes were on display during Wednesday's afternoon vote. Leaders in both parties used traditional maneuvers in attempts to secure their desired outcome.

Democratic leaders attempted to pass the bill quickly by closing the vote while Republican lawmakers were out of their seats. Meanwhile, Republican leaders and their staff rushed behind the House chamber glass to corral colleagues who were wavering on expansion.

Rep. Kenneth Fredette, R-Newport, the House minority leader, at one point scrambled his staff to find Republican lawmakers who "were soft" on expansion and make sure they voted the caucus position. LePage's staff was also dispatched.

Some Republicans attempted to "take a walk" during the vote, a common practice on controversial issues that allows lawmakers to avoid being recorded during the vote, while helping the opposing party.

Republicans later accused Democrats of attempting to ram the bill through and using other legislation as leverage to convince wavering lawmakers to vote for expansion.

House Speaker Mark Eves, D-North Berwick, said Wednesday that Democrats would do whatever they could to expand Medicaid.

"Maine Democrats will never stop fighting for health care and jobs for Maine people," Eves said. "We will continue to call on Republicans' common sense and compassion to do what's right for the people they represent."

Fredette said the vote Wednesday showed Democrats had not been able to convince Republicans of the merits of Medicaid expansion. He accused the majority party of attempting to "muscle it through" the Legislature.

"We were appalled by the Democrats' actions and are united in our belief that those tactics don't belong here in Maine," Fredette said. After the evening vote Eves said supporters had done everything they could.

He said expansion failed "because of one person -- and that person is Gov. Paul LePage."

"We fought hard for health care for working people in our state," he added in a statement. "We stood up and fought for them. We never wavered and we never faltered. We might not have the numbers today, but we showed we had the heart and the fight. We will not stop fighting for health care."

Maine's participation in expansion as outlined in the federal health care law has faced long odds.

A majority of Republicans rejected the Democrats' first Medicaid expansion effort, a bill that combined expansion with a bipartisan plan to pay Maine's hospitals $186 million in outstanding payments. The compromise crafted by Katz attempted to ease Republican concerns by including federal reimbursement guarantees, an independent cost-benefit study and "hard sunset" that would end the program after the first three years of full federal funding.

Republican resistance, however, proved constant and fluid, moving from concerns about the federal government's ability to fund the program, to cost overruns in the state's Medicaid program, MaineCare. More recently the opposition shifted attention to a waiting list of severely disabled Mainers who currently receive health coverage but are waiting for additional services for which they qualify.

The waiting list is also the subject of a May 28 court action that effectively compelled the LePage administration to cover qualified recipients. The state's next two-year budget proposal devotes about $10.4 million to extend services to residents on the waiting list.

Medicaid expansion would extend coverage to adults without children who earn as much as $20,500 a year. Under the amended bill, eligibility would expire after three years, when federal reimbursements for the program are scheduled to decline from 100 percent to 90 percent unless the Legislature takes additional action.

The federal government now pays 62 percent to cover about 10,500 Maine adults without children. It would likely increase reimbursement to 100 percent from 2014 to 2016 before gradually dropping to 90 percent, according to a letter from the Centers for Medicare and Medicaid Services.

Maine also would receive 100 percent funding to cover about 50,000 additional childless adults under Medicaid expansion.

Maine already provides Medicaid to about 15,000 non-disabled parents, as defined in the federal health care law. According to the Centers for Medicare and Medicaid Services, the state would continue to receive its current reimbursement of 62 percent.

Expansion isn't expected to add parents, but it would prevent the 15,000 parents from losing coverage on Jan. 1 because of changes enacted by the Legislature last year.

According to a fact sheet distributed by the Centers for Medicare & Medicaid Services, states have the flexibility to start or stop the expansion, but the 100 percent reimbursement is set by the Affordable Care Act.

States will receive 100 percent support for in 2014, 2015, and 2016; 95 percent in 2017, 94 percent in 2018, 93 percent in 2019; and 90 percent by 2020, remaining at that level thereafter.

Twenty-one states have chosen not to participate in Medicaid expansion this year. Six states are still debating the issue.

The Medicaid issue could play into the 2014 election. U.S. Rep. Mike Michaud, D-Maine, who is exploring a run for governor urged Democrats to fight for expansion and he visited the House Democratic caucus in May to push the issue. Earlier this week Michaud released a statement through his exploratory committee asking lawmakers to override LePage's veto and support Katz's amendment.

"Gov. LePage has said 'no' to a plan that would have helped Maine's economy, protected rural hospitals, created nearly 4,500 jobs and helped to improve the lives of men and women who work, but can't afford health insurance," Michaud said.

Independent candidate Eliot Cutler also urged lawmakers to override the governor's veto.

"It's sad that a bipartisan coalition of legislators worked so hard to develop and pass complicated legislation that is in the best interest of all Mainers, only to have Gov. LePage once again make the wrong choice for Maine," Cutler said in a statement.

(c)2013 Portland Press Herald