Maine spoke yesterday, and they said loud and clear they want to expand Medicaid. But Governor LePage, who is notoriously against that approach to healthcare, is refusing to heed the will of the people until the state legislature finds a way to pay for the change. How this plays out could be a litmus test for other states considering Medicaid expansion under the Affordable Care Act and could influence members of Congress who are trying to sort out the Trump administration’s determination to repeal and replace Obamacare.
“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget,” said Governor LePage. “Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated, and I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.”
But the voters who approve of expansion have a different take on what Maine needs. “More than 70,000 Mainers have already waited too long for health care,” explained David Farmer, who worked on the expansion campaign. “They shouldn’t have to wait any longer. The governor cannot ignore the law or the Constitution of Maine. Simply put, the governor does not have veto power of citizen’s initiatives and he cannot ignore the law.”
Those 70,000 Mainers are within 138% of the federal poverty level, which makes them eligible for income-based Medicaid if the state votes to expand. That also means that 90% of the expansion would be paid for by the federal government, according to the Affordable Care Act. So when LePage says he wants the legislature to figure out how to fund this, he really means the final 10% of the pie. That distinction doesn’t matter much to state Republicans, who feel this is a dangerous expansion of government. It’s understandable that they are gun-shy, given that the last time Maine expanded Medicaid over a decade ago, it resulted in budget shortfalls that had to be amended by LePage with wholesale liquor revenues.
However, with that lesson under their belts, the legislature can explore other possibilities for where to get the remaining $54 million needed to cover expansion. Meanwhile, Idaho and Utah have been keeping their eye on Maine’s Medicaid fight and are considering similar legislation to bypass similarly reticent lawmakers in office. Given the Trump administration’s struggle to develop a meaningful, actionable alternative to Obamacare, Medicaid expansion will certainly be one of the hottest topics in the 2018 midterm elections as America grapples with how to handle healthcare.