Last night, Maine voters approved expanding Medicaid in their state with almost 60 percent support. That means some 80,000 low-income adults could qualify for health insurance under the program, according to independent estimates from a Maine legislative fiscal office. Yesterday marked the first time voters have directly authorized expansion, or voted on the issue at all, attempting to work around an intransigent governor.
But the state’s Republican governor and Trump ally, Paul LePage, said today that he’ll refuse to expand Medicaid until state lawmakers find the means to pay for it. LePage vetoed legislation to expand Medicaid coverage five times, which led to a campaign to put the issue on the ballot in the first place.
“Expanding” Medicaid allows anyone with income up to 138 percent of the poverty level ($16,642 for an individual, $24,600 for a family of four) to enroll in the program, with states and the federal government footing the bill. Under the Affordable Care Act, the federal government pays the cost of new enrollees for the first three years after expansion, and will continue to pay at least 90 percent of the cost. In 2012, the Supreme Court struck down the ACA provision that required every state to expand Medicaid; as a result, 19 (mostly red) states have chosen not to expand.
“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget,” LePage said in a statement. “Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS”—the state’s Department of Health and Human Services—“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.”
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Of the 18 other states that have refused to expand, all but Virginia and North Carolina are led by a Republican governor. Before Maine, the most recent state to authorize expansion was Lousiana, almost two years ago, when Democrat John Bel Edwards took the governorship and quickly signed an executive order doing so.
Activists are looking to put Medicaid on the ballot next year in states including Utah and Idaho, where state legislators have similarly quashed expansion efforts. Not all Republican governors are against it, though: The governors of Tennessee, Wyoming, and South Dakota, tried to persuade lawmakers to back expansion plans but have been unsuccessful.
The Republican-dominated legislature in Kansas backed expansion, which would have made 150,000 low-income Kansans eligible, only to have it vetoed by Governor Sam Brownback, also a Republican. (Soon after, a poll showed Brownback as America’s least popular governor, second only to New Jersey’s Chris Christie.)
Supporters of expanding Medicaid say doing so can create jobs, provide healthcare to a vulnerable population (including uninsured people with addiction), and support cash-strapped rural hospitals which often have to cover the cost of care for those who can’t afford to pay. Maine’s hospitals supported the initiative, saying charity care costs them more than $100 million a year.
LePage, meanwhile, summarizes his opposition by saying: “Free is expensive to somebody.” In addition to decrying Medicaid as a form of welfare, LePage says the expansion would require diverting $54 million in state funds from other programs, including those for the elderly, disabled, and children.
LePage seems to relish opposing voters, but he may not have much power to thwart their will. Mainers for Health Care, the organization that backed the expansion campaign, says the governor can’t simply ignore the ballot initiative. “Under the state constitution, 45 days after the legislature reconvenes, Medicaid expansion will become the law of the state,” David Farmer, the group’s spokesman, told Talking Points Memo. The state DHHS then creates an implementation plan, and the expansion would go into effect in mid-August 2018. “If the governor isn’t willing to follow the law,” Farmer added, “we will take it to the courts if necessary.”
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