A Week From Tomorrow Maine Voters Decide On Medicaid Expansion

A week from tomorrow voters in Virginia and New Jersey will pick between lesser-of-two evils candidates the two corrupted political parties selected for them. That night I'll be watching returns for the Virginia House of Delegates, where there are some extraordinarily good candidates running who have a real chance to win. And I'll be watching what's happening in Maine. Maine? Yeah, Maine has the first referendum in the country on expanding Medicaid under the Affordable Care Act. The state legislature passed it 5 times and the TRumpist governor, Paul LePage vetoed it 5 times.

Mainers want it. Last year all 16 counties in Maine rejected Clinton and backed Bernie in the state's caucuses. He won the urban centers, the suburbs and the rural areas. Bernie's win numbers by county:

• Androscoggin- 64.7%
• Aroostook- 54.9%
• Cumberland- 63.2%
• Franklin- 67.2%
• Hancock- 66.0%
• Kennebec- 59.6%
• Knox- 68.1%
• Lincoln- 67.0%
• Oxford- 72.2%
• Penobscot- 66.0%
• Piscataquis- 65.0%
• Sagadahoc- 63.3%
• Somerset- 62.0%
• Waldo- 73.3%
• Washington- 73.3%
• York- 65.2%

Statewide, Bernie beat Hillary 64.3% to 35.5%. On election day a proposition passed legalizing recreational marijuana use (56.4% to 43.6%). Maine's a hunting state and a proposition to ban large-capacity ammunition magazines and requiring a background check to purchase ammo passed 62.7% to 37.3%. A $2.00/a pack cigarette tax passed 63.8% to 36.2% and a proposition preserving bilingual eduction passed 72.8% to 27.2%. Over the weekend, the NY Times looked at the proposition for expanding Medicaid Mainers will vote on next week.

The referendum on Nov. 7 represents a new front in the pitched political battles over health care. Maine is one of 19 states whose Republican governors or legislatures have refused to expand Medicaid under Obamacare, and the other holdouts-- particularly Utah and Idaho, where newly formed committees are working to get a Medicaid expansion question on next year’s ballot-- are closely watching the initiative, whose outcome may offer clues about the salience of the issue in next year’s midterm congressional elections.

After President Trump and Republicans in Congress spent much of the year trying to repeal the health law and cut spending on Medicaid, a half-century-old entitlement program that covers one in five Americans, the pro-expansion side in Maine is hoping to benefit from energized public support for it.

Turnout may be the biggest challenge for the advocacy groups leading the effort. There are no national or statewide races here to drive people to the polls this year. And Mr. LePage’s stance on government safety net programs appeals to many voters in the state’s more rural regions. He derides Medicaid expansion as “pure welfare” that would burden the state’s taxpayers.

Senator Susan Collins of Maine, one of the few Republicans who firmly opposed the Obamacare repeal bills, is not taking a position on the ballot measure-- she never does on referendums, according to her staff. But leaders of the campaign are hoping her outspoken support for Medicaid during the repeal battles will help.

About 80,000 additional Mainers would become eligible for the program if the ballot measure were to succeed, according to the nonpartisan Maine Office of Program and Fiscal Review, although those with income above the poverty line currently qualify for subsidized coverage through the Obamacare marketplace. In all, more than 2.5 million poor uninsured adults across the country would gain access to Medicaid if the holdout states expanded the program, joining about 11 million who have already signed up under the law.

...The main arguments for expanding the program here are that it would help financially fragile rural hospitals, create jobs and provide care for vulnerable people who have long gone without it.

But Mr. LePage and other opponents say that Maine should know better. The state undertook a more modest expansion of Medicaid in 2002, under former Gov. Angus King, an independent. Afterward, Maine struggled with budget shortfalls and fell behind on Medicaid payments to hospitals.

“People don’t want to acknowledge the unintended consequences that Maine has already experienced,” said Brent Littlefield, a political adviser to Mr. LePage who is serving as the spokesman for Welfare to Work, the committee leading the opposition. He said that even with the federal government paying most of the cost-- a situation that could change if Congress eventually succeeds in repealing Obamacare-- the state could owe close to $100 million a year, according to estimates from the LePage administration.

The Office of Program and Fiscal Review has estimated a lower state cost, about $54 million a year once the federal share drops to 90 percent in 2021. Maine would not receive the full 90 percent match for parents of young children because many already qualify for the program.

Maine’s legislature, which is controlled by Democrats in the House and Republicans, by one vote, in the Senate, could move to block the referendum if it were to pass, but since it voted for Medicaid expansion five times already, supporters and opponents alike believe it is unlikely to meddle. And the governor would have no authority to veto the outcome. The only other threat would be if Congress succeeded in repealing the Affordable Care Act and ended the Medicaid expansion program.

Supporters of the measure have knocked on 150,000 doors since July and have run four television ads statewide. Mainers for Health Care had raised about $480,000 as of early October, including $375,000 from the Fairness Project, a left-leaning group founded in California. It is putting out national appeals for donations, including through Organizing for Action, the political group that grew out of former President Barack Obama’s campaigns.

Welfare to Work had raised $192,500, with its contributions coming from a handful of frequent Republican donors in the state. Mr. Littlefield would not discuss the opposition’s strategies, but the group has at least two ads running on television statewide and Mr. LePage has been blasting the initiative on talk radio and in other public comments.

This is what voters will see at the polls:

Do you want Maine to expand Medicaid to provide healthcare coverage for qualified adults under age 65 with incomes at or below 138% of the federal poverty level, which in 2017 means $16,643 for a single person and $22,412 for a family of two?

So far all the newspapers that have weighed in, have supported expansion. The Press Herald: "A 'yes' vote," they wrote, "would bring in more than $500 million a year from the federal government, which would be distributed throughout the state to hospitals-- including struggling rural hospitals-- along with clinics and doctors’ offices, supporting an estimated 4,000 health sector jobs. Those workers will cash their paychecks, buy houses, pay taxes and contribute to the economic health of their communities, generating another 2,000 jobs.

For economic impact alone, we would enthusiastically support this referendum, which would give the state a much-needed shot in the arm.

But there are many other reasons to vote yes that are just as compelling. This is a bill that will make Maine’s health care system more reliable and secure for everyone. It will extend access to preventive care and treatment for people who can’t now afford it. And it will save lives.

By passing this referendum, Maine would extend health coverage to an estimated 70,000 people who are not currently eligible for MaineCare, despite earning less than $16,642 for an individual, or $22,411 for a family of two. Some of the people covered would be childless adults who earn less than the federal poverty limit of $12,060 a year, but still can’t get coverage now. More than two-thirds of those who’d be newly eligible are currently working, or actively looking for work, but don’t have employer-provided insurance.

At those incomes, visits to a doctor or filling a prescription are not in the budget. Low-income people often wait until they are very sick before they start to seek help, often at hospital emergency departments. By then, their care might be much more expensive than preventive care would have been. It also might be too late to help them at all.

Even if they have no insurance, those patients are not turned away by hospitals. Instead, they receive “free” care, the cost of which is shared by all the hospital’s paying customers. That results in higher insurance premiums for everyone else.

Opponents typically argue that Maine can’t afford to expand because the state’s 10 percent share of the program, projected to cost $54 million by 2021, would be too much of a burden.

But they are ignoring the benefit the state would get in return from the federal spending on health care. Most investors would be willing to put up $10 dollars to get $100 back, and Maine should be willing to take that deal, too.

Thirty-one states have participated in Medicaid expansion, and there is plenty of evidence that it has not broken the bank.

Instead, expansion states report not only that their state budgets are stable, but that their hospital balance sheets are positive and insurance rates are lower than in non-expansion states.

This is a good deal. It’s time Maine took part in this program.

This is a good deal for Maine, and voters shouldn’t let this opportunity slip away again.

Jared Golden, the Majority Whip of the Maine state House, is the progressive running in Maine's 2nd congressional district. He reiterated that "the Maine Legislature has passed Medicaid expansion five times but the governor has killed it with his veto pen each time. Passage of Question 2 would bring about a half billion federal dollars per year into Maine to extend coverage to roughly 70,000 Mainers that have lacked health coverage for all these years because of the governor's opposition to a functioning government and his lack of compassion for people that are living in poverty. The governor says they need to pick themselves up by their bootstraps but they don't have boots. He's forgotten that his were given to him by kind people that were there to give him a hand up but not everyone is so fortunate. The frustrating part is that expanding Medicaid to those 70,000 folks would also create thousands of good paying, middle-class health care jobs in Maine, giving our economy a much needed boost, particularly those jobs that would be supported in our rural hospitals and health care providers. In Congress, I'll fight to protect Medicaid funds so that Maine's elderly, many of whom use it for long-term care and assisted living, and people struggling in poverty with low-wages can continue to receive health care coverage through this important program."