Maine is the only state whose voters have approved expanding Medicaid to low-income residents, but expansion originally set for Monday is in limbo as a legal battle between the fiscally conservative governor and advocates continues.
Nearly three out of five voters last fall voted to expand Medicaid to 80,000 Mainers. It was the first time since former President Barack Obama’s Affordable Care Act took effect four years ago that the expansion question has been put to voters.
Roughly 11 million people nationwide have gained coverage through the expansion in 31 states of Medicaid, the state-federal health insurance program for lower-income Americans. Since Maine voters OK’d Medicaid expansion last fall, Virginia lawmakers voted to expand Medicaid, and expansion initiatives are set to appear on ballots in Utah and, potentially, in Nebraska and Idaho.
Late last year, Republican Gov. Paul LePage swore to block expansion unless lawmakers provided funding under his terms for Maine’s share of expansion. Lawmakers this month finally sent the governor a funding bill he’s demanded, but LePage vowed to veto it as a legal battle continues.
Meanwhile, the state faces lingering questions about the fate of expansion, the cost of the governor’s efforts to block Medicaid and the impact of potential work requirements.
COURT BATTLE
Maine’s successful ballot measure came after LePage vetoed five attempts by the politically divided Legislature to expand the program and take advantage of the federal government picking up most of the cost.
The governor ignored an April deadline to submit the necessary paperwork to eventually receive more than $500 million in annual federal funding for expansion.
Then, advocacy groups and potential Medicaid recipients filed suit. Advocates warned that even if LePage didn’t comply with the court order, Mainers on July 2 would apply for Medicaid coverage they’re owed under state law.
Maine’s highest court said LePage doesn’t have to file the paperwork while he appeals a recent lower-court order requiring him to start rolling out expansion. Legal arguments are set for July 18, and advocates are encouraging Mainers to apply for Medicaid expansion Monday even though the LePage administration’s not ready for a surge in applicants.
The governor disputes the estimated, first-year cost of about $30 million after savings and says lawmakers should recall their “hasty, ill-conceived” funding plan that relies on surplus and tobacco settlement funds. “We cannot afford to return to the days of out-of-control spending on Medicaid and a $750 million debt to our hospitals,” he stated Friday.
Peter Miller, an Ellsworth man who lost Medicaid eligibility in 2013 under LePage-era cuts, said he hasn’t followed the political and legal twists and turns.
“I gave up on the hope of this going my way,” said Miller, who cannot afford weekly treatments for a blood clot and resorts to keeping old asthma inhalers in a bowl in his living room. He said his pay as a prep cook isn’t enough for him to qualify for financial assistance to help him afford health insurance under Obama’s law. “I’m just hoping that I survive,” he said.
WORK REQUIREMENTS
LePage has said he considers Medicaid another form of welfare that will bankrupt his state. His plan to require certain recipients to work and pay premiums exempts those who prove they’re physically or mentally unable to work.
Four states — Kentucky, Indiana, Arkansas and New Hampshire — have had their 20-hour-a-week work requirements approved by Republican President Trump’s administration, a development that has won over some GOP lawmakers long opposed to Medicaid expansion. Virginia is set to seek federal permission for such restrictions, while Utah wants a limited Medicaid expansion with work requirements.
But the future of such work requirements is unclear as seven states, including Maine, await federal permission for their own plans. On Friday, a federal judge blocked Kentucky’s work requirements and has ordered the Trump administration to reconsider the program.
LePage’s plan to limit Medicaid coverage to three months in a 36-month period for those who don’t meet work requirements has gone little discussed as advocates lawyer up, but observers like Maine Primary Care Association Board President Martin Sabol said they’re worried. LePage’s administration predicts an unknown number of “able-bodied” adults will lose coverage under a plan that could save Maine roughly $130,000 annually.
“There often aren’t a whole lot of jobs available to people who don’t have a lot of job skills,” said Sabol, who directs health services at a community health care center serving 5,500 patients. “Folks are going to be losing their coverage, and that’s going to mean we’re going to have a whole lot more uncompensated care.”
LEGAL COSTS
Meanwhile, LePage’s legal costs are mounting. Democratic Attorney General and gubernatorial candidate Janet Mills has refused to represent LePage in the ongoing Medicaid lawsuit, and has allowed him to retain Boston lawyer Patrick Strawbridge.
LePage’s office hasn’t responded to requests for Strawbridge’s billing for Medicaid litigation.
But Maine’s online database of governmental spending shows Maine’s risk management claims fund paid out $16,478 on May 25 to Strawbridge’s firm Consovoy McCarthy Park. The fund’s paid out $92,000 this year to the firm, which has represented the governor in four legal matters in the last year.