Governor LePage has for weeks insisted that supporters of the Medicaid expansion, estimated to enroll between 70,000 and 100,000 able-bodied adults without children, come up with a way to pay for the expansion without cutting certain services, raising taxes or raiding the state’s rainy day fund.
In doing so, LePage has put the responsibility for drawing a road map to a sustainable funding source on Rep. Gattine, who is a Medicaid expansion
Photo courtesy Rep. Drew Gattine’s Facebook page. Gattine believes Governor Paul LePage should find the money for Medicaid expansion even though LePage has insisted Maine can’t afford it.
supporter, and his pro-expansion colleagues in the Maine Legislature.
Historically, neither Democrats or Republicans have felt compelled to fully fund spending initiatives passed by referendum. In 2004, Maine voters strongly supported a referendum to force the state to pay 55% of local public school funding, but the Maine Legislature, under the control of both Democrats and Republicans in the years that followed did not achieve that funding rate until a state budget passed earlier this year.
Lepage’s position on the referendum and Medicaid expansion in general has broadly been that the state does not have the funds, estimated at more than $50 million per year in the state budget, to afford the expansion. He has also expressed concerns that future changes at the federal level could reduce future federal funding match rates, exploding the state’s share of the overall costs.
The Governor and his allies have also demanded that the state budget provide full funding for disabled and elderly Mainers who have been placed on waiting lists for state services before funding a new expansion for able-bodied adults.
Any proposal to fund Medicaid expansion at the levels required will likely need broad bipartisan support to be included in any supplemental state budget passed by the Legislature in the coming legislative session.
Photo courtesy Paul LePage, Maine’s Governor Facebook page. Governor LePage has insisted that supporters of Medicaid expansion, who circumvented the Legislature with a referendum, find a way to pay for the program without cuts to certain programs, tax hikes or raiding the state’s rainy day fund.
As the House Chairman of the Legislature’s Health and Human Services Committee, Rep. Gattine could play a key role in molding that compromise, but a public battle with Governor LePage, who holds veto power over that budget, is unlikely to advance a conversation about a sustainable solution.
Maine’s last Medicaid expansion effort left the state with a perpetual budget shortfall and led to the accumulation of hundreds of millions of dollars in unpaid bills to Maine hospitals. Opponents of Medicaid expansion say they are worried the new proposal will return Maine to the dark days of constant financial crisis, while supporters of expansion cite the higher reimbursement rate offered by the federal government as the reason this expansion will not play out like the last one.
Senator Eric Brakey (R-Auburn), who serves as Gattine’s Senate counterpart on the Health and Human Services Committee, was very firm in his position after the passage of Medicaid expansion at the ballot box, “As Senate Chairman for the Health and Human Services Committee, my priorities remain clear: Maine’s most vulnerable come first. I will not vote to spend a penny on Medicaid Expansion for able-bodied adults while our seniors and intellectually-disabled adults go without basic services.”
Other states have taken novel approaches to funding their state’s share of Medicaid expansion. Arkansas, Colorado, Indiana and other states have used fees or taxes on hospitals and large medical providers who see a significant financial benefit from the expansion.
A number of states have established copayment requirements for individuals who receive Medicaid benefits as a result of expansion. Several states have also proposed or established a premium requirement for some recipients of Medicaid who became eligible under the Affordable Care Act’s expansion.
Some supporters of Medicaid expansion in Maine have threatened to sue the state if there is an attempt to establish copays or premiums as part of Maine’s Mediciad expansion.
Whether the salvo launched by Gattine is a precursor to Medicaid expansion supporters offering a true compromise on the issue, or the start of them digging in to try and make LePage and Republicans who opposed the expansion share the pain of implementation won’t be known until early next year.