The bill addresses three top issues facing lawmakers: Who should get the state liquor contract?; How should that contract be used to pay back the nearly half-billion dollars owed to hospitals?; and whether to expand Medicaid.
Democrats and Republicans have sparred at length this legislative session over their competing plans to pay back hospitals, but that debate took a back seat Monday to the question of Medicaid expansion, which many Republicans, like Sen. Garret Mason oppose.
"So what is this bill?" Mason asked. "Well, it's a massive welfare expansion to 70,000 people."
Right away, Democrats like Sen. John Patrick from Oxford County took issue with the term "welfare." "If welfare is providing health care to those working men and women living on the margins, barely scraping by, living on poverty wages, I will take that vote each and every day," said Patrick.
For Democrats, expanding Medicaid is more than a moral issue, it's an issue of life and death. Many senators told emotional stories about their constituents' lack of insurance coverage. Sen. John Cleveland of Androscoggin County said he knows a 28-year-old woman with cystic fibrosis. Her husband works, and she used to, but had to stop because of her illness.
"She received a notice in April, last month, that because of the changes made here, which is similar to this Mediciaid expansion, that the state of Maine has terminated her from her health insurance," he said. "Because she is no longer income eligible, and she fell off the cliff. For her, that's a death sentence."
Republicans said they have compassion for Mainers like these, but there are too many unknowns with the Medicaid expansion. The federal government said it will pay 100 percent of the expansion for three years, then taper to 90 percent coverage.
Republican Sen. Roger Katz of Augusta said it's unclear how much that will cost the state. Plus, Katz said, Gov. LePage is in the midst of negotiations with the federal government to try to get a better deal for the expansion.
"That could save the state tens of millions of dollars a year in perpetuity," he said. "Why wouldn't we want that process to continue?"
Republicans also resent that the expansion was tacked on to the bill to pay back the hospital debt, saying combining the two issues together threatens the whole plan to pay back hospitals. But Democrat John Patrick said it makes sense to link the two ideas.
"Paying back the hospitals and reducing charity care is a win win for everybody." Patrick said. "I didn't hear a flock of hospitals coming and said don't combine it. Because they're going to benefit greatly, millions upon hundreds of millions of dollars."
More than 85 Maine organizations, including the Maine Medical Association and the Maine AARP support expanding Medicaid. The president of the AARP, Rich Livingston, said the Legislature has to act this session to take full advantage of what the federal government is offering.
"If we don't accept this money now, it will go away. It will be given to somebody else," Livingston said. "We won't be able to get it later. The time is right now."
Livingston spoke at the State House with others as part of the Cover Maine Now Coalition. The group delivered 3,000 petitions to lawmakers on Monday to urge them to expand Medicaid. While there was success in the Senate today, the bill still faces additional votes in the House and Senate.