North of the Mason-Dixon Line, it is hard to find a state that has given more of a cold shoulder to President Obama’s health law than Maine.
It was one of 27 states that joined the suit to overturn the law, which was eventually largely upheld by the Supreme Court.
This year the state not only showed no interest in expanding Medicaid under a key provision of the law, it took steps to shrink the rolls of the state-
federal health insurance program for the poor, leaving thousands without coverage. In September, the state sued the federal government to reduce the program further, arguing a provision in the law barring states from making it harder for people to qualify was invalid.
But Maine’s voters may have short-circuited further resistance Tuesday by initiating a Democratic sweep that flipped control of both houses of the State Legislature and is now poised to challenge Governor Paul LePage, a Republican who opposes the law.
“A new direction is likely to prevail,” Terry Hayes, assistant Democratic leader in the Maine House, said in an interview. “We will look to fully implement the Affordable Care Act.”
LePage congratulated the victorious lawmakers, but his spokeswoman had no comment on how the political switch might affect implementation of the health law.
“It certainly changes the dynamics,” said Senator Roger Katz, a Republican member of the Appropriations Committee. But he noted that LePage could veto Democratic efforts to restore Medicaid cuts or to expand the program.
“Hopefully we can work together,” Katz said.
Maine is one of five states – along with Minnesota, Colorado, New York, and Oregon — in which Democrats won control of legislatures Tuesday. But the shifts in Maine and Minnesota, where a Democratic governor supportive of the law had previously battled with Republicans, are likely to have the greatest impact on the health law’s implementation.
Hayes, whose district is in rural northwest Maine, said Democrats will work to implement the law’s key provisions. That means they will look to expand Medicaid to cover everyone under 133 percent of the federal poverty level, currently $31,000 for a family of four. They also support creating a state-based insurance exchange.
LePage, elected during the 2010 GOP wave, has vehemently opposed setting up an exchange, going so far as to return a $5.8 million federal grant for that purpose.
The Maine Legislature’s power shift also means Democrats will get to appoint a new state attorney general in January and thwart threatened lawsuits against the Obama administration related to the law, Hayes said. “We will not be suing the federal government anymore to impede the Affordable Care Act,” Hayes said.
About 44,000 people could be eligible for Medicaid if the state expands the program under the law in 2014. The federal government will pay the full costs through 2016, after which Maine would have to pay up to 10 percent.
Sara Gagné Holmes — executive director of Maine Equal Justice Partners, a consumer group that represents the poor — said Democrats’ takeover of the Legislature is good news for the uninsured.
“We are certainly more optimistic of having an expansion taking place,” Holmes said.
Maine earlier this year cut more than 14,000 parents from Medicaid when it lowered the threshold to qualify from 200 percent of poverty level ($46,100 for a family of four) to 133 percent ($31,000 for a family of four).
This summer, the state submitted plans to the federal government to cut another 36,000 people, including childless adults with incomes above the poverty level ($23,050 for a family of four), as well as 19-and 20-year olds who had been covered up to 150 percent of the poverty level ($34,575 for a family of four). When the Obama administration did not respond quickly enough, the state filed suit in federal court requiring an “expedited review,” but a court tossed the case, saying it lacked merit.
The LePage administration had been counting on the cuts to balance the state budget.
Joseph Ditre, executive director of Consumers for Affordable Health Care, said Democratic lawmakers are more likely to favor a more aggressive exchange model, which negotiates with insurers to keep rates down for consumers. The federal health law gives states flexibility to establish different types of exchanges. He said the state does not have enough time to establish its own exchange by 2014, but it could start one in 2015.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.