Amid ACA Debate, Maine Inches Closer to Expanding Medicaid

AP Photo/Robert F. Bukaty

Governor Paul LePage delivers the State of the State address to the Legislature, Tuesday, February 7, 2017, at the State House in Augusta, Maine. 

Maine Governor Paul LePage has been never a fan of the Affordable Care Act’s Medicaid expansion provisions, which he has long criticized as too costly. State lawmakers have disagreed, passing bills to expand Medicaid five times during LePage’s six-year tenure. The cranky Republican vetoed every one, and despite bipartisan support for the original proposals, the legislature has never mustered the votes to override his vetoes. Maine remains one of 19 states that have declined to accept new federal dollars to extend health insurance to more low-income people.

Exasperated by LePage’s opposition and the obstinacy of a small group of House Republicans, Mainers for Health Care, a statewide coalition of more than 100 health care, social services, and other organizations, has decided to bypass Augusta. In October, the organizers launched a campaign to put a Medicaid expansion ballot question before voters. If approved, the measure would mandate that Maine accept the federal dollars that would allow state officials to extend Medicaid coverage to individuals under age 65 with an income below or equal to 133 percent of the federal poverty level ($32,252 annually for a four-person family).

The coalition collected most of the 61,123 signatures needed to advance the petition during an Election Day signature-gathering drive. This week, Maine’s secretary of state announced that organizers had gathered 66,434 signatures, more than enough to qualify the initiative for the November ballot. However, the next major hurdle for Maine is not at the ballot box but on Capitol Hill, courtesy of Republicans who are determined to obliterate Obamacare in its entirety, right along with the provisions that expand Medicaid to qualifying low-income people.

In Maine, more than 70,000 people stand to gain health insurance coverage under a Medicaid expansion. The move would also create about 3,000 new health sector jobs, establish a wider array of drug treatment programs in a state ravaged by the opioid epidemic, and provide more financial resources to struggling rural hospitals.

Robyn Merrill, executive director of Maine Equal Justice Partners, a nonprofit legal aid group that helped pull together the campaign, canvassed voters in the town of China near Augusta on Election Day. She found that despite the divisiveness of the presidential election, both Trump supporters and Clinton voters were enthusiastic about the ballot question. During the signature collection drive, Merrill and other canvassers heard many health-care horror stories, including a sobering tale from an uninsured woman who cut her hand and sewed the wound up herself rather than go to a hospital. Only when the wound became infected did a friend convince her to go an emergency room. She landed in serious debt after the treatment. Voters “recognized that the lack of affordable health care is just a problem that needs to get solved,” Merrill says.

State lawmakers have the opportunity to weigh in on the referendum before it goes to the ballot in November. If LePage vetoes the bill again and lawmakers fail to override, the measure would still go before voters in November. However, if Maine lawmakers pass the bill in the coming weeks and override LePage’s expected veto, the measure would become law and the question would not appear on the ballot.

The Maine Republican Party claims that the ballot question is “a moot point and a waste of state resources” since congressional Republicans plan to dismantle the ACA. In their “Obamacare Repeal and Replace” policy brief, House Republicans stipulate that expansion states would receive additional Medicaid money only for a limited time once a new law goes into effect; during that period, non-expansion states like Maine “could be eligible to receive additional temporary resources for safety net providers.”

If Maine passes an expansion measure in time, the state could receive federal funding under the ACA before any new law goes into effect. “At the very least, passing this referendum and putting it into law would put us into a much better bargaining position as a state to make sure that we are drawing down that money and covering these people even if [Congress does] something like put it into block grants,” argues Mike Tipping, of the Maine People’s Alliance, a economic and social justice organizing and education group backing the ballot question.

Nationwide, opponents of the current Republican “repeal and replace” strategy, such as the AARP and the U.S Conference of Mayors, have stepped up efforts to force the GOP to stand down from its assault on the law. Republican lawmakers, too, continue to hear from their own constituents who are outraged by the possible loss of newly acquired health insurance—another development that may further slow the Republicans’ march to repeal the ACA without having a comprehensive alternative in place.

Since he came into office in 2011, LePage has waged a relentless assault on services for low-income people in the poorest state in the Northeast. His fiscal 2018-2019 budget plan slashes $140 million from the state Department of Health and Human Services budget, a 4.5 percent decrease from the previous two-year budget, that includes a Medicaid eligibility change that would save $33 million but force about 20,000 people out of the program.

LePage has yet to weigh in on the Medicaid expansion ballot question, but he has expressed little faith in voters’ ability to make informed decisions on state policy issues. He continues to dismiss four successful ballot initiatives that voters passed in November, including a minimum wage increase and marijuana legalization. The governor has suggested that voters did not understand the questions and would like to see new curbs on the referendum process. Nevertheless, Mainers may indeed decide to overrule their term-limited, lame-duck governor by adding Medicaid expansion to the list of issues that are nudging the Pine Tree State in a more progressive direction.  

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