Dr. Renee Fay-LeBlanc, chief medical officer for Greater Portland Health, speaks at Monday’s news conference to encourage Mainers eligible for health care coverage under the state’s Medicaid expansion law to file applications with the DHHS. (Portland Press Herald photo)

Dr. Renee Fay-LeBlanc says she has a patient with diabetes who can’t afford insulin or blood-sugar monitoring devices to help manage the disease.

Another of her patients can’t afford inhalers to manage her chronic lung disease and has been hospitalized during the recent hot weather.

Still another patient with a heart condition can’t afford the newer drugs that don’t require costly heart monitoring.

Fay-LeBlanc, chief medical officer for Greater Portland Health, on Monday joined a group of advocates for Maine’s voter-approved Medicaid expansion law to urge those who may be newly eligible for the state and federally funded health care program to apply for it as soon as possible.

“Sixteen years’ worth of studies have shown that health insurance saves lives,” Fay-LeBlanc said at a Portland news conference. “As a practicing physician who has lost patients due to the lack of health insurance, I know this to be true.”

Fay-LeBlanc said the patients all were examples of people who may have “access to care” because they can be seen by her but their chronic illnesses go uncontrolled because they remain unable to afford medication or ongoing monitoring and testing.

“But it is even worse than that,” Fay-LeBlanc said. “Even people without serious or chronic health conditions suffer from lack of insurance coverage because they cannot afford routine preventive care.”

She said patients living in poverty routinely decline preventive care because of the cost.

“This causes diseases like cancer and diabetes to go unnoticed until they have progressed to a stage where they are more expensive to treat, more difficult to treat, and more likely to cause death,” she said.

Republican Gov. Paul LePage has opposed expanding Medicaid under the Affordable Care Act unless the Legislature can identify a sustainable funding mechanism for the program that would provide coverage to an additional 70,000 low-income Mainers, those who earn 138 percent of the federal poverty level – $16,753 for an individual or $34,638 for a family of four.

On Monday, he vetoed a bill that would have provided about $60 million in funding for the first year of the program, while also covering the cost of adding 110 workers to the Department of Health and Human Services staff to help manage cases in an expanded program.

This is the sixth time LePage has vetoed a Medicaid expansion bill passed by the Legislature, and in his first term in office he pushed through legislation that cut thousands of low-income single adults from the program. In his veto message Monday, LePage said he considers the vetoes among his most important actions as governor over the last eight years.

“The Medicaid expansions of past administrations were some of the most destructive public policies in modern Maine history,” LePage wrote, “creating hundreds of millions of dollars in hospital debt, crowding out funding for critical budget priorities, regularly creating massive budget shortfalls, hurting the state’s credit rating, creating upward pressure on the state’s tax burden, and perpetuating a culture of dependency that once solidified Maine’s status as a welfare state.”

LePage’s also said in a radio address in June that DHHS will deny applications they do not have time to review.

“If DHHS does not determine whether a person is eligible for Medicaid within 45 days, that person becomes entitled to full coverage – regardless of the merits of the application,” LePage said. “This will force DHHS to simply deny all applications they don’t have time to review. We have to avoid putting the state on the hook for medical bills of potentially hundreds and even thousands of people.”

Emily Spencer, a spokeswoman for the department, said in an email to the Press Herald on Monday that applications would be processed based on the date of submissions and in the order they were received.

Lynnea Hawkins of Lewiston, who is currently covered under MaineCare, the state’s Medicaid program, said she was once among the thousands of Mainers without health care coverage. She said that is part of why she served on the leadership team for Mainers for Health Care, which helped promote the ballot box law in 2017.

Hawkins took direct aim at LePage, saying Monday was not just another day on the calendar but a date in law.

“It may seem like just another day and the governor continues to exercise the power over who should get life-saving access to care,” Hawkins said. “He can try to delay and confuse people about what the issue is. But we are not confused; we know this has always been about getting health care for people who can’t afford a doctor’s visit or a prescription. People who work hard but simply don’t have enough for rent, food, and medical bills, so they skip their medical care.”

About 273,000 Mainers are currently covered under Medicaid.

Maine Equal Justice Partners, a nonprofit that advocates for the poor in Maine and was a driving force behind the ballot initiative, has set up a telephone hotline and added to its website to help provide people with information and support as they try to apply for benefits.

Kathy Kilrain del Rio, a policy analyst with the organization, said it also offered to work with the DHHS to help ensure applications could be submitted and processed in a timely fashion. Kilrain del Rio said it’s not likely that people will get coverage quickly by applying soon, but they may be eligible for retroactive coverage for health costs once the new law is fully implemented.

“People who believe they might be eligible for health care coverage should file an application, which will help protect their rights to coverage,” Kilrain del Rio said.

Under current law, if Medicaid applications were simply left in limbo, applicants would become automatically eligible after 45 days. The denial of coverage would trigger an appeal process, which may buy LePage more time while the Maine Supreme Judicial Court considers his appeal of a Kennebec County Superior Court order that he submit a Medicaid expansion plan to the federal government.

Maine Equal Justice Partners sued LePage over the expansion law in May and the lower court ordered LePage to file an expansion plan with the federal Centers for Medicare and Medicaid Services. If approved, the plan would trigger the flow of federal funds to support the expansion. That order was stayed by the high court while it considers LePage’s appeal, which is scheduled for a hearing on July 18.

LePage’s veto of the funding bill could make his argument before the high court more difficult to sustain, as he has previously argued he doesn’t have the authority to appropriate funding for the expansion and that only the Legislature can do that.

In November 2017, 59 percent of voters supported a ballot question directing Maine to join the more than 30 other states that have expanded Medicaid as part of the Affordable Care Act.

There are conflicting assessments over how much expansion would cost the state, even with the federal government footing 90 percent of the bill. While a recent study funded by the Maine Health Access Foundation estimated it will cost roughly $30 million in the current two-year budget, the LePage administration has pegged the costs at $60 million during the first year and as much as $100 million annually in future years.

Roughly 11 million people in 31 states have gained coverage through the expansion of Medicaid, the state-federal health insurance program for lower-income Americans. Since Maine’s vote last fall, Virginia lawmakers voted to expand Medicaid, and expansion initiatives are due to appear on ballots in Utah and, potentially, in Nebraska and Idaho.

Scott Thistle can be contacted at 713-6720 or at:

sthistle@pressherald.com

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