Governor Paul LePage of Maine got a sharp rebuke from voters last month, when they overwhelmingly approved a ballot question to expand the state’s Medicaid program under the Affordable Care Act. LePage had repeatedly vetoed legislative efforts to cover those up to 138 percent of the federal poverty level, despite the generous funding Obamacare provides.
Faced with LePage’s recalcitrance, advocates of expanded care then gathered signatures and went to the ballot with a question asking voters to approve such an expansion. They did, with 59 percent voting yes. (LePage, by contrast, hasn’t won an outright majority in either of his two gubernatorial campaigns.) The governor’s response has been to throw up obstacles and conditions, saying he won’t implement the expansion unless the Legislature first funds Maine’s share without raising taxes, using rainy-day funds, or diverting money from services for the elderly or disabled.
That stubborn stance puts him at odds not just with Maine voters but also with the state’s constitution, which doesn’t give the governor discretion over whether to follow through on ballot laws. Indeed, it specifically declares that “the veto power of the Governor shall not extend to any measure approved by vote of the people.”
The ballot law directs the state to submit its application for expanded Medicaid funds within 90 days and to have the new, expanded Medicaid program in place and covering people within 180 days. If LePage tries to thwart the new law, advocates say, he should expect to find his administration in court.
“We have formed a legal team that is ready if necessary,” notes Robyn Merrill, cochair of the Mainers for Health Care campaign.
In an e-mail, Peter Steele, LePage’s director of communications, disputed the idea that LePage was trying to thwart the will of the voters. “The Governor is simply asking the Legislature to be fiscally responsible in implementing Medicaid expansion,” he wrote. Asked twice via e-mail if LePage would propose his own funding plan, Steele did not reply. But LePage obviously has no interest in working toward a solution here.
The Maine Legislature, where the House is led by Democrats, the Senate by Republicans, seems more willing to step to the policy plate. The House Appropriations Committee meets next week to start focusing on how to fund and implement the new law.
Initially, that shouldn’t be horribly difficult. The first (half) year costs are estimated at $13.6 million, which even in Maine, where the annual budget is $6.8 billion, isn’t a huge sum. Maine’s nonpartisan Office of Fiscal and Program Review estimates that the cost will grow to $54 million or so when the law is fully implemented and the federal ACA reimbursement settles back to the long-term 90 percent federal, 10 percent state funding match, in 2020. For that sum, Maine could leverage more than a half-billion in federal health care dollars and cover an additional 80,000 people.
Finding the state money may take some work and willingness to compromise. But there’s good news on that front as well. LePage leaves office in the beginning of 2019. The new governor, be he or she a Republican or a Democrat, should be more respectful of the will of Maine voters.