AUGUSTA, Maine — Maine Republicans who are fiercely fighting an effort to expand government-subsidized health care coverage to roughly 70,000 residents have come up with an alternative: government-subsidized health care.
The lawmakers have long opposed President Barack Obama's signature health insurance law. But now they are promoting one of its main provisions, cheap and federally subsidized private plans available through the law's insurance marketplaces, as a way to keep the state from acting on another part of the law, an expansion of Medicaid.
"We understand this is the law that we have to work with right now," said Republican Rep. Deb Sanderson of Chelsea. "This is the hand that we've been dealt. We have a bad hand and worse hand and, for Maine, Medicaid expansion is the worse hand."
Maine, one of six states that hasn't decided whether to expand Medicaid under the health care law, is gearing up for another round of debates on the topic Wednesday.
Democrats hope to get enough support for expansion to overturn a certain veto from Republican Gov. Paul LePage, who's rejected two previous attempts to pass the bill. But many Republicans remain staunchly opposed despite the inclusion of provisions designed to attract their votes, such as implementing managed care in the Medicaid program.
Republicans, whose opposition to Medicaid expansion has centered on the hefty costs to the state, have recently shifted their focus to highlight that Mainers can instead get private plans for as little as $5 or $10 a month. Some lawmakers have even started handling out pamphlets and explaining to protesters about their options on the marketplace, also called an exchange.
As part of the health care law, the federal government pays for part of some plans on the marketplace through income-based tax credits or subsidies. In Maine, more than 25,000 residents have already picked plans, surpassing the goal of having 23,000 residents signed up by the end of the open enrollment period in March.
But Democrats and advocates point to the fact that those making less than roughly $12,000 a year won't get help to pay for plans on the exchange, which would be about 24,000 Mainers, according to the Kaiser Family Foundation. They criticized the Republican tactic to push such plans.
"It's a desperate ploy at the 11th hour to appear to be concerned about the health care of 70,000 people," said Democratic House Speaker Mark Eves of North Berwick. Maine has the opportunity accept federal dollars that will not only provide health care coverage to all those who need it in Maine, but will also bring significant benefits to the state's economy, he said.
"If this does not pass, I think going to be reflected on both as a bad human decision and a bad business decision," he said. "You don't forgo this kind of money and there not be consequences for our economy."
Advocates for Medicaid expansion contend that the subsidies aren't a viable alternative for many low-income Mainers.
Many will likely be drawn to plans on the exchange that have the lowest monthly premiums, but those plans don't offer subsidies to help reduce the total out-of-pocket cost, said Sara Gagne-Holmes, executive director of Maine Equal Justice Partners. That means people who buy them will be on the hook for much higher costs when they seek care, she said.
Senate Republican Leader Michael Thibodeau of Waldo is quick to say that Republicans are by no means supporting the health care law with their efforts. In fact, he questions whether the subsidies will be sustainable long term. They merely hope to point out what options Mainers have that won't result in continued dependence on a state-run program, he said.
"This exists," he said. "I don't know for how long. But I think Mainers should take advantage of it while it's there."