Maine Votes by Ballot Measure to Expand Medicaid, but the Governor Remains Opposed

Maine has become the latest state to expand Medicaid under the Affordable Care Act, but it did so in a unique way. The state was the first to allow voters to weigh in on the issue through a ballot measure.

The measure was a product of a campaign from Mainers for Health Care! after the Maine Legislature passed legislation on 5 separate occasions to expand Medicaid using earmarked federal funds, but the bill was ultimately vetoed each time by Republican Governor Paul R. LePage.

The campaign got the measure on the ballot by obtaining signatures from more than 66,000 Mainers and the endorsement of more than 200 businesses and organizations.

The ballot question appeared as: "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?"

“Maine voters have made it clear: They want more people to have access to healthcare,” Robyn Merrill, co-chair of Mainers for Health Care!, said in a statement. “Medicaid expansion will provide health care coverage to more than 70,000 Mainers and bring more than $500 million a year in new funding into the state, helping our hospitals and creating an estimated 6,000 jobs. Tonight is a great night for the people of Maine and our economy.”

However, Maine’s governor remains opposed to expanding the program.

“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget,” LePage said in a statement on Wednesday morning. “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.”

LePage opposed expanding Medicaid because it would cost the taxpayers hundreds of millions of dollars in order to provide healthcare to working-age, able-bodied adults. He noted that the state had previously tried to implement a more modest expansion of Medicaid in 2002 under then-Governor Angus King, an Independent, and that the experiment did not work.

“[The experiment] created a $750 million debt to hospitals, resulted in massive budget shortfalls every year, did not reduce emergency room use, did not reduce the number of uninsured Mainers and took resources away from our most vulnerable residents—the elderly and the intellectually and physically disabled,” LePage said.

The Mainers for Health Care! campaign is now turning its attention to ensuring the expansion actually gets implemented.

“Starting tomorrow, we will turn our focus to the quick implementation of Medicaid expansion,” Merrill said. “There can be no more delays.”

The governor might become more amenable to Medicaid expansion with the latest move by the Trump administration to provide states more flexibility with implementing expansion. The same day Mainers were voting to expand the program, CMS Administrator Seema Verma announced that the agency would encourage states to propose reforms that include work requirements.

Work requirements are one of the ways red states that have not yet expanded Medicaid are interested in altering the program in order to expand it, and the proposal has support among voters. A poll by Morning Consult/Politico at the end of August found that 51% of Americans supported the idea of requiring individuals to work in order to be eligible for Medicaid.

“Every American deserves the dignity and respect of high expectations and as public officials we should deliver programs that instill hope and say to each beneficiary that we believe in their potential,” Verma said during a speech at the National Association of Medicaid Directors fall conference. “CMS believes that meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being, and health of Americans.”