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Maine governor threatens to thwart Medicaid expansion approved by voters

Advocates of expanding health coverage for low-income Mainers say they will fight Governor Paul LePage if he ignores the will of the voters.

By Globe Staff 

Governor Paul R. LePage of Maine, stung by the overwhelming passage of a ballot measure to expand insurance coverage for low-income residents, made clear Wednesday that he will continue to fight against expanding Medicaid coverage under the Affordable Care Act.

In a defiant statement issued a day after nearly 60 percent of Mainers voted for broader health insurance coverage, LePage said he will not implement the law until it is fully funded by the Legislature.

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Expanding Medicaid, he said, “will cost taxpayers hundreds of millions of dollars to give ‘free’ health care to working-age, able-bodied adults, most of whom do not have dependents.”

The Maine People’s Alliance, which was part of the coalition of advocacy groups that supported the referendum, said LePage — who vetoed five previous Medicaid expansion proposals approved by state lawmakers — cannot thwart the will of the voters, who backed the referendum 59 percent to 41 percent on Tuesday.

“The most important point here is that he can’t veto a vote of the people,” said Mike Tipping, an alliance spokesman. “So his comments are unprecedented, and his threats are likely illegal, and it’s another unfortunate degradation of our political norms.

“But we shouldn’t let his tantrum distract from this landslide victory and the final decision of the people of Maine.”

The passage of the ballot measure, known as Question 2, will make Maine the 32nd state to expand Medicaid coverage under the federal health law, but the first to do so by a popular vote, rather than by a decision of the Legislature and the governor.

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It will extend coverage to about 80,000 Mainers who earn up to 138 percent of the federal poverty level, or $33,948 for a household of four.

The Office of Fiscal and Program Review, a nonpartisan state budget office, estimates the law will cost Maine $54.5 million annually and bring in an additional $525 million in annual federal aid. LePage’s Department of Health and Human Services estimates the costs to the state will be much higher — $63 million in the first year and $100 million in future years.

The governor argues that the last time Maine expanded Medicaid, under then-governor Angus King in 2002, it created a $750 million debt to hospitals, resulted in budget shortfalls, and did not reduce the number of uninsured residents.

“Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated,” LePage said Wednesday, referring to the Department of Health and Human Services, “and I will not support increasing taxes on Maine families, raiding the rainy-day fund or reducing services to our elderly or disabled.”

John McDonough, a Harvard School of Public Health professor, said that any attempt by LePage — a famously pugnacious Republican who has called himself “Donald Trump before Donald Trump” — to block the law will trigger lawsuits from Mainers who are being denied coverage to which they are legally qualified.

“Can a governor do things to impede, and slow down, and thwart?” said McDonough, who worked on development and passage of the federal health law. “I think the answer is yes. And I don’t think that authority or power is limitless in the face of a law passed by the voters.”

He said he hopes the referendum’s passage encourages activists in other states like Utah and Idaho that have not expanded Medicaid coverage to take the issue to the ballot.

“I hope it creates a kind of a wave and really exemplifies and makes concrete the gap in opinion between voters and the people who are trying to repeal, replace, and dismantle the ACA,” McDonough said.

But funding for the insurance coverage could face roadblocks in the Maine Legislature, where Democrats control the House and Republicans the Senate.

Representative Kenneth W. Fredette, the House GOP leader, acknowledged Wednesday that Medicaid expansion is now “the law of the land” but expressed doubts about funding it.

“It’s the question of: Do you want a new car?” Fredette said on WVOM, a Maine radio station. “Well, yes, of course you’d like to have a new car. But how do you pay for it? Well, I think that’s the fundamental question.”

Echoing LePage, he said House Republicans will not support raising taxes or dipping into the rainy-day fund to expand Medicaid coverage for the poor. “House Republicans are going to be very stingy — much like we were in this past budget conversation — about how we are going to continue to pay for an ever-expanding government,” he said.

House Speaker Sara Gideon, a Democrat, blasted LePage and Fredette for what she described as their attempts to obstruct the results of the election. She said the Legislature will move swiftly to fund Medicaid expansion, as required by law.

“Mainers want more access to health care, not less, and are no longer willing to wait,” Gideon said in a statement. “Any attempts to illegally delay or subvert this law will not be tolerated and will be fought with every recourse at our disposal.”

Michael Levenson

can be reached at mlevenson@globe.com.

Follow him on Twitter @mlevenson.