Earlier this week the people of Maine went to the polls and voted overwhelmingly to support a referendum aimed at expanding Medicaid eligibility to approximately 70,000 residents who currently live below 133% of the federal poverty line.

Voters for the first time used the ballot box as the road to achieving Medicaid expansion under the Affordable Care Act.  Other states like Utah, Idaho, and Virginia that are considering Medicaid expansion via state referendums will be waiting in the wings to see how this all plays out.

Funding?

Estimates show the Medicaid expansion would bring about $500 million in federal funding to Maine each year; it would also cost the state approximately $50 million a year.  Furthermore, voter approval may not be enough to enact the bill.

The Governor of Maine, Paul LePage, a Republican and a staunch opponent of Medicaid expansion, in a public statement said “credit agencies are predicting that this is fiscally irresponsible.  Medicaid expansion will be ruinous to Maine’s budget. Therefore, my administration will not implement Medicaid expansion until it is 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.”LePage added, “expansion will give free health care to working-age, able-bodied adults, most of whom do not have dependents.”

Into the Long Grass

Currently, people in Maine who make too much for traditional Medicaid and who are not eligible for subsidized health insurance on the federal marketplace fall into a coverage gap.

Maine is a state with an aging population, factory closings, and an opioid epidemic, where voters saw this as a path to make healthcare affordable to that population. Senator Susan Collins (R-ME) voiced major concern around the GOP reform proposal because the plan would pull the rug out from under too many in her state currently covered by Medicaid.  Remember, she was one of the “no” votes that killed the Republicans efforts to repeal and replace Obamacare.

Governor LePage is not going to dismiss the will of the voters completely, but he will not make it easy either.  By putting it in the hands of the legislature, lawmakers will have to debate and contest the ability of how, or if, they can pay for this plan.  After all, four ballot initiatives passed by voters in Maine a year ago have been delayed, changed in scope, or completely overturned.

States considering putting Medicaid expansion on the ballots in the future might also want to include increased tax initiatives simultaneously, thus avoiding the dilemma of how to pay for the expansion.

Across the Spectrum

The tactic of passing initiatives via referendum at the state level may feel like an “end-around play,” however, it is nothing new.  The Republicans did it many times in the 1990s when the Democrats were in control, so none of this should come as a surprise.

The recent failed attempts by the GOP to repeal and replace have left Republicans in a very vicarious and exposed position.  Due to their inability to negotiate and pass “something” on healthcare reform, they very well could be left with “nothing” and ultimately responsible for resuscitating Obamacare.

Will the bill become law in Maine?  Will other states follow suit?  We at Liberty Nation will continue to follow and report on updates.