Kari Medeiros, 40, of Eastport, a tiny town in the state’s poorest county, earns less than $5,000 a year cleaning houses and pet sitting, and has back pain that has worsened to the point where she can barely mop and sweep.

“With MaineCare I believe I’d be able to find a provider who would see me,” she said, referring to the state’s Medicaid program. “But a lot of people here don’t vote. So many families here are having addiction problems with their loved ones, and they’re not focused on going to vote — even though those are the people that need it the most.”

Under the Affordable Care Act, the federal government picked up the entire cost of new enrollees under Medicaid expansion for the first three years and will continue to pay at least 90 percent. (States cover a significantly larger portion of the expenses of the regular Medicaid program.) The law allows any citizen with income up to 138 percent of the poverty level — $16,642 for an individual, $24,600 for a family of four — to qualify.

The main arguments for expanding the program here are that it would help financially fragile rural hospitals, create jobs and provide care for vulnerable people who have long gone without it.


R.J. Miller, 33, who suffers from psoriatic arthritis that causes severe joint pain and swelling, said he worries about relying indefinitely on free care to control his condition.

Sarah Rice for The New York Times

But Mr. LePage and other opponents say that Maine should know better. The state undertook a more modest expansion of Medicaid in 2002, under former Gov. John Baldacci, a Democrat. Afterward, Maine struggled with budget shortfalls and fell behind on Medicaid payments to hospitals.

“People don’t want to acknowledge the unintended consequences that Maine has already experienced,” said Brent Littlefield, a political adviser to Mr. LePage who is serving as the spokesman for Welfare to Work, the committee leading the opposition. He said that even with the federal government paying most of the cost — a situation that could change if Congress eventually succeeds in repealing Obamacare — the state could owe close to $100 million a year, according to estimates from the LePage administration.

The Office of Program and Fiscal Review has estimated a lower state cost, about $54 million a year once the federal share drops to 90 percent in 2021. Maine would not receive the full 90 percent match for parents of young children because many already qualify for the program.

Maine’s legislature, which is controlled by Democrats in the House and Republicans, by one vote, in the Senate, could move to block the referendum if it were to pass, but since it voted for Medicaid expansion five times already, supporters and opponents alike believe it is unlikely to meddle. And the governor would have no authority to veto the outcome. The only other threat would be if Congress succeeded in repealing the Affordable Care Act and ended the Medicaid expansion program.

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The Governor Blocked Medicaid Expansion. Now Maine Voters Could Overrule Him. – New York Times