Mayors from the six of the largest cities in Maine are urging the federal government not to grant waivers that could eliminate health care for 27,000 low-income residents. 

In a joint letter to U.S. Health and Human Services Secretary Kathleen Sebelius, mayors from Biddeford, Portland, Saco, South Portland, Waterville and Westbrook wrote that the cuts to Medicaid, or MaineCare, will have a financial and human impact on the state’s major service centers. 

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Portland Mayor Michael Brennan: "We represent the front line and the costs associated with the these cuts will be paid for by our residents." AP

The cuts were passed last spring by the Legislature in a budget advanced by Gov. Paul LePage. The governor said the reductions were necessary to achieve $19.93 million in savings and balance the state’s two-year budget.

A debate is raging over whether the governor’s proposal requires a federal waiver from the Affordable Care Act. Officials with the Centers for Medicare and Medicaid Services, the federal agency whose approval is needed to pass the state’s amended Medicaid plan, suggested that the state’s request is “inconsistent” with the law.

Portland Mayor Michael Brennan, in a written statement, said that while the debate has focused on Washington and the State House, “it is important to note that it’s the cities and towns of Maine that will have to bear the burden and address the impact on the health and lives of our residents.”

“We represent the front line and the costs associated with the these cuts will be paid for by our residents, our hospitals and our businesses whether through increases in charitable care, rising health insurance premiums or by taxing our safety net with more families turning to City Hall for help,” Brennan said. 

In the letter to Sebelius, the mayors noted that it may be tempting to reduce Medicaid offerings during difficult budgetary challenges. However, the letter continued, tough economic times were also a reason to maintain health care for low-income residents. The mayors also pointed to a recent report in the New England Journal of Medicine that showed that expanded Medicaid coverage in Maine reduced mortality rates among adults. 

Accounting for some overlap, the changes would end benefits for an estimated 24,000 parents, 6,848 19- and 20-year olds and 1,825 Medicare recipients who also receive limited benefits under Medicaid, which operates in Maine as MaineCare.

Although the cuts appear to require a waiver of Medicaid standards that the federal Health and Human Services Department has never granted to any state, the LePage administration contends that such waivers are no longer necessary, because of the U.S. Supreme Court’s decision in June on the Affordable Care Act.

Others contest that interpretation of the court ruling and maintain that it doesn’t affect the type of waiver that would apply to Maine’s request.

The dispute over the waiver requirement could lead to another lawsuit. If the state loses, it could be forced to reimburse the federal health department for the $19.93 million in expected savings, which Maine drew on to balance its budget this year.

In Gov. Paul LePage’s cover letter to Sebelius earlier this month, the governor stressed that the cuts are necessary to preserve the state constitutional mandate for a balanced budget.

Sebelius is expected to rule on the state’s Medicaid plan next week. The federal department has 90 days to act on the state’s request, but Maine has asked for a ruling by Sept. 1.