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On Tuesday, Maine could become the 33rd state to expand Medicaid under the Affordable Care Act.
Mainers will vote tomorrow on a long-awaited ballot initiative that, if passed, would expand Medicaid to cover anyone living below 133 percent of the federal poverty line. That works out to about 80,000 Maine residents gaining coverage, according to the state's nonpartisan Legislative Office of Fiscal and Program review.
Maine would also become the first state to expand Medicaid by ballot initiative, and that could encourage other nonexpansion states to take the same route.
Medicaid expansion actually has a fair amount of bipartisan support in Maine. Earlier this year, I wrote about a Republican state legislator named Tom Saviello who has repeatedly introduced bills to expand the Medicaid program.
“The people I represent need this,” he told me. “It’s as simple as that.”
The legislature has actually passed five separate bills to expand Medicaid. But Maine Gov. Paul LePage, a Republican, has vetoed all of them. Unsurprisingly, LePage has also been a vocal opponent of the upcoming ballot initiative, too. Here's what the governor said in a radio address last week:
This Medicaid expansion is not for children or the elderly. They are already covered by Medicaid.
This Medicaid expansion would give “free” health care to able-bodied adults who can work and contribute to their own health insurance costs.
I’ve said it before: “Free” is very expensive to somebody. This time, it will cost Maine taxpayers up to $500 million in the next five years. Maine learned this the hard way when it expanded Medicaid in 2002.
LePage is likely citing numbers from Maine Heritage Policy Center, a conservative think tank in the state that has estimated Medicaid expansion will create an additional $50 million or $100 million in state spending.
But this isn't the whole story. A nonpartisan state office estimates that Maine will spend $55 million extra next year if it expands Medicaid — but will also draw down an additional $525 million in federal spending. So the state kicks in a bit more spending, but gets a whole lot of federal money in return.
Is it going to pass? Generally, the idea of expanding Medicaid polls quite well — people like the idea of getting federal money to help provide health insurance to more people. Unfortunately, there is frustratingly little polling on the Maine ballot initiative. There is one poll that found that 69 percent of registered voters support Medicaid expansion, but I've had experts who follow the issue caution me about how accurate this poll is (because it includes only registered voters and not likely voters).
If it does pass, though, I would not be surprised to see other states try to follow in Maine's footsteps. You could see a state like Kansas (where the governor has vetoed multiple expansions) trying something similar.
Even if it does pass, Medicaid expansion isn't a guarantee. Harvard's Emma Sandoe notes that there are still ways for Gov. LePage to oppose the Medicaid expansion — and possibly block it — even if the vote does come out against him. Here's what she writes:
In Maine the governor has the ability to declare that there is not enough funding available and the initiative must go back to the legislature for approval within 45 days of the start of the session. This ballot question requires that the state submit a plan to the US Department of Health and Human Services within 90 days of the initiative taking effect. However, Maine has a history of slow walking initiatives in the state and failing to implement them all together.
As Sandoe goes on to note, getting legislative approval for funding shouldn't be a huge hurdle. This is a body that has approved Medicaid expansion five times now, after all. But it still shows that a vote on Tuesday may not be the final word on Medicaid expansion in Maine.
Chart of the Day:
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Kliff’s Notes
Your daily top health care reads, with research help from Caitlin Davis
News of the day
- “Trump readies executive order to unravel Obamacare's individual mandate, GOP Senator says”: “The Trump administration has prepared an executive order that would unravel Obamacare's individual mandate, but has put it on hold to see whether repealing the penalties for going uninsured might be included in the Republican tax bill instead, a GOP senator told the Washington Examiner.” —Kimberly Leonard, Washington Examiner
- “Maine Voters Could Expand Health Care To 70,000 People On Election Day”: “If the ballot initiative ― Question 2 ― to establish the expansion passes, it would mark a major win for progressive health care activists, the state’s hospital industry and, most of all, the estimated 70,000 Mainers who would gain health coverage as a result.” —Jeffrey Young, Huffington Post
- “‘Unprecedented’ Pentagon health committee could undermine FDA”: “The Defense Department — and not FDA — would have the power to approve drugs and medical devices under the defense policy bill that’s being hammered out by a conference committee, alarming congressional staff and Health and Human Services officials who say it would undermine medical safety and potentially put soldiers at risk.” —Dan Diamond, Politico
Analysis and longer reads
- “Community health centers fear federal funds will come too late, leading to cuts in prevention efforts”: “While many community health center officials remained hopeful Congress would eventually approve the funding, the continued uncertainty over when it may come has forced some providers to begin looking at what services they may need to cut in order to stay afloat.” —Steven Ross Johnson, Modern Healthcare
- “Harris scrutinizes opioid treatment drug manufacturer”: “She may not have the same legal tools she had as California’s attorney general, but Democrat Kamala Harris is aiming to use her perch on the Senate’s chief oversight committee and her rising national profile to shine a light on the marketing practices of Big Pharma.” -—Emily Cadei, McClatchy
- “First look: Dem group aims to register a million "health care voters"”: “A Democratic group is launching a year-long, "multi-million dollar" campaign to register and mobilize one million "health care voters" to vote against Republicans who are trying to repeal and replace the Affordable Care Act.” —Alexi McCammond, Axios
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