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Congresswoman Chellie Pingree urges Obama Administration to reinforce Affordable Care Act policy

Congresswoman Chellie Pingree wrote to Department of Health and Human Services Secretary Kathleen Sebelius this week asking her to reaffirm federal regulations prohibiting big cuts in the Medicaid program in Maine. The health care reform law contains a maintenance of effort (MOE) provision that requires states to maintain their Medicaid programs through 2014 at the same level that was in place when the law was passed.

"As you continue to examine the potential implications of the Supreme Court's decision, and develop guidance for states on the current and future implementation of the ACA, I strongly hope that you will reaffirm your commitment to the MOE requirement. It is clear to me that the Governor's proposed elimination of Medicaid coverage would not only adversely affect the health and wellbeing of Maine residents and upset Maine's local economies, it would also be in direct violation of the MOE requirement, even in the wake of the Supreme Court's ruling," Pingree wrote.

At issue are Governor LePage's proposed cuts to Medicaid (MaineCare) that would eliminate coverage for three groups of people: Seniors and people with disabilities in the Medicare Savings Program, 19 and 20 year olds, and parents with incomes between 100% and 133% of the Federal Poverty Level. The proposed cuts would result in a loss of coverage for roughly 27,000 Maine residents.

Under the health care reform law, states are required to maintain existing Medicaid programs until the new health insurance exchanges open in 2014. The LePage Administration has suggested that the recent Supreme Court decision upholding the health care law undoes that requirement, because the ruling limited Congressional power when it comes to expanding Medicaid.

Pingree disagreed with that assessment and wrote to Sebelius to urge her to issue clear guidance to that effect.

Earlier this year, Pingree got involved when the LePage Administration asked the Maine Legislature to make those cuts without getting a waiver from HHS that would exempt Maine from the law's requirements. In that case, Sebelius made it clear that Maine would most likely not qualify for the proposed waiver.

Full text of the letter is below

Dear Secretary Sebelius:

With the U.S. Supreme Court's recent decision upholding the Patient Protection and Affordable Care Act (ACA), I look forward to continuing to work with you to implement the law in a manner that maximizes access to high quality, affordable health care for every American. Thank you for all of your efforts in this regard.

I have written to you previously about my concerns regarding Maine Governor Paul LePage's proposals to drastically reduce individuals from the state's Medicaid rolls, including elimination of coverage for three populations that are currently protected under the ACA's Medicaid maintenance of effort (MOE) provisions:

· Seniors and people with disabilities in the Medicare Savings Program

· 19 and 20 year olds

· Parents with incomes between 100% and 133% of the Federal Poverty Level

Earlier this year, Governor LePage publicly asserted that it was his intent to seek a waiver from CMS to exempt Maine from the ACA's Medicaid MOE provision that requires states to maintain Medicaid coverage levels from the time the ACA was signed into law in March of 2010 until the newly authorized expansion of Medicaid in 2014. If granted, this waiver would result in a loss in coverage for roughly 27,000 Maine residents.

The Governor's stated reason for pursuing this waiver was to alleviate state budgetary pressures. As he never officially applied for such a waiver, CMS was unable to issue a definitive decision as to the validity of his request, but did respond to the inquiry of concerned state legislators by issuing clear guidance that these waivers were not intended for states to cut eligibility solely for budget-driven reasons.

In light of the Supreme Court's recent decision to uphold the ACA in its entirety, while limiting Congressional power to mandate that states must expand and create new Medicaid programs in 2014, the Governor has now reversed course,announcing that he intends to cut Medicaid eligibility and eliminate coverage without applying for a waiver from the MOE requirements. Additionally, the State Attorney General has gone on record saying that it is his interpretation that the Supreme Court's ruling regarding Medicaid expansion also invalidates the MOE requirements.

It is my strong belief that the portion of the ACA decision pertaining to Medicaid expansion in no way undermines or annuls state responsibility to maintain existing Medicaid programs until 2014 as delineated by the MOE requirement.

As you know, the Supreme Court upheld the constitutionality of the ACA, including the Medicaid expansion. It did, however, limit the penalty that may be applied to states that decline to expand to the withholding of new funds, rather than withholding all existing Medicaid funds. In reaching this conclusion, the Chief Justice went to great lengths to define the planned 2014 Medicaid expansion to all individuals under the age of 65 with incomes up to 133% of the Federal Poverty Level as a "new health care program."

The Court did not determine that it would never be permissible to condition federal funds based on compliance with specific requirements set by the federal government. In fact, the Court distinguished the limitation on requirements under the "new program" from previous conditioning of federal Medicaid funds on the basis that previous expansions affected groups that states already agreed to cover, which would include parents with dependent children, and seniors and people with disabilities – the groups that are clearly covered by the MOE requirements but facing proposed cuts under the Governor's plan.

It is important to note the MOE requirement is not discussed anywhere throughout the Court's decision. The limitation on the penalty of conditioning funding for the existing program applies only to the contemplated Medicaid expansion. What may be required of states through 2014 – including MOE requirements – remains untouched by this decision.

As you continue to examine the potential implications of the Supreme Court's decision, and develop guidance for states on the current and future implementation of the ACA, I strongly hope that you will reaffirm your commitment to the MOE requirement. It is clear to me that the Governor's proposed elimination of Medicaid coverage would not only adversely affect the health and wellbeing of Maine residents and upset Maine's local economies; it would also be in direct violation of the MOE requirement, even in the wake of the Supreme Court's ruling.

I appreciate your consideration of the critical and time-sensitive nature of this issue for states like Maine, and would welcome the opportunity to further discuss this with you.

Sincerely,

Chellie Pingree

Member of Congress