- The Washington Times - Sunday, October 22, 2017

Maine voters will decide in November whether to expand their Medicaid rolls under Obamacare, offering a major test of the public’s appetite for government-funded insurance as Congress decides whether to rein in or build on the 2010 law that swelled the federal footprint in health care.

The Maine Legislature has tried five times to grab federal dollars that let states extend the insurance program for the poor to more able-bodied adults. Yet Republican Gov. Paul LePage has vetoed each try, saying expansion would bust the state budget and offer a new form of welfare instead of focusing Medicaid’s resources on the truly needy.

Fed up, signature-gatherers were able to put the issue directly to voters on the Nov. 7 ballot.

Supporters say it would be foolish not to join the 31 states and the District of Columbia that have leveraged generous federal funding that picks up the lion’s share of the cost of expanding Medicaid coverage to those making up to 138 percent of the federal poverty level.

Expansion would make 70,000 Maine residents newly eligible for coverage and bring more than $500 million into the state per year, translating to 6,000 new jobs, according to supporters’ estimates.

They’re also encouraged by shifting winds in Washington, where Republican attempts to kill the Affordable Care Act have languished amid pushback from Senate Democrats and Maine Sens. Angus S. King Jr., an independent, and Susan M. Collins, a Republican who defected against repeal.

Recent polling suggests Obamacare is more popular than ever and that voters want to build on the law rather than tear down its progress in expanding government-funded coverage. Proponents of the ballot push say Maine is no different.

“Like voters elsewhere, they want more health care, not less. They want premiums to be more affordable, not more expensive. And they want more people to have health care coverage,” said David Farmer, spokesman for Mainers for Health Care, which supports the initiative. “Expanding Medicaid helps to accomplish all three.”

President Trump has vowed to take another crack at repealing Obamacare next year, making November’s vote in a politically diverse state such as Maine a kind of national barometer for the law’s durability.

Yet analysts say the on-the-ground campaign largely has focused on what the initiative means for Mainers, their health and their pocketbooks, rather than focusing on the national fight. Many progressives are looking beyond Obamacare and toward a government-run, single-payer system.

“The people voting ‘yes’ aren’t necessarily people who like everything about the Affordable Care Act,” said James Melcher, a politics professor at the University of Maine, Farmington. For some, it’s “much more of a statement about universal coverage.”

Many blue states opted to expand Medicaid under President Barack Obama immediately, in 2014, though some GOP-led states followed in later years, tempted by federal matching funds that pick up nearly all of the costs of the new population — a share that will drop to 90 percent in 2020 and beyond.

Deep-red Kansas nearly joined the ranks of expansion states earlier this year, as GOP plans to repeal Obamacare faltered on Capitol Hill, but Gov. Sam Brownback vetoed the expansion effort, citing the same budgetary concerns that preceded Mr. Trump’s arrival.

Likewise, opponents of the Maine initiative said efforts to expand Medicaid in 2002 ended in a fiscal disaster, with “massive” hospital debts, job cuts and state budget woes.

“We can’t go back,” says a statewide television ad funded by Welfare to Work PAC, a key group in opposition.

Supporters say 2002 is a poor comparison because the effort didn’t include generous federal matching funds and ran into an economic downturn.

Yet Brent Littlefield, a political strategist assisting the opposition, said it’s a misnomer to think the state budget can sustain its share of the expansion under Obamacare. State estimates say expansion will cost state taxpayers at least $50 million per year, and outside groups say annual costs could reach $100 million.

“Maine has a lot of trees, but that state taxpayer money is not going to just fall out of them,” Mr. Littlefield said.

Both sides said there is no reliable polling on the issue so far since the issue is just starting to pick up steam in the home stretch to Election Day.

A ballot question to allow slot machines or gambling in York County, and an effort to consolidate the cities of Lewiston and Auburn, may drive turnout in some areas. Yet it is still an off-year election, so turnout will be low and the fate of Medicaid expansion unpredictable.

“I think it has a lot to do with who mobilizes better,” Mr. Melcher said.

Mr. LePage, the governor, is urging residents to vote “no” after his administration worked to remove able-bodied adults from the Medicaid rolls and encouraged them to get covered through a job.

“Maine should not expand Medicaid for adults who are capable of working. We should continue to direct our limited resources toward the truly needy: the elderly; low-income people; and those with intellectual and physical disabilities,” he said in a recent weekly address.

“We must stay on our fiscally responsible path,” he said. “We cannot let socialists use big money from out of state to reverse all of the progress we have made.”


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