Maine residents hope ballot box will do what legislators couldn't: Expand Medicaid to more low-income adults

Maine hospitals and patient advocates hope voters in the state will do what the legislature hasn't been able to—expand Medicaid.

A coalition of Democratic and moderate Republican state lawmakers passed bills five times that would have had Maine apply for federal Medicaid expansion money to cover low-income able-bodied adults without children at home. Gov. Paul LePage vetoed them each time.

Both Florida and Montana had previously tried to expand Medicaid through a ballot initiative, and neither effort gathered enough signatures. By contrast, Maine collected the 67,000 signatures on a single day — election day, last year.

Opponents of the ballot initiative, whose PAC is called Welfare to Work, had challenged the ballot language suggested by Mainers for Health Care, which said: "Do you want Maine to provide health insurance through Medicaid for qualified adults under the age of 65 with incomes at or below 138 percent of the federal poverty line (which is now about $16,000 for a single person and $22,000 for a family of two)?"

They said the question should ask if Maine should provide government-funded health benefits.

The Maine Secretary of State announced Thursday that the ballot question will read: "Do you want Maine to expand Medicaid to provide healthcare coverage for qualified adults under age 65 with incomes at or below 138% of the federal poverty level, which in 2017 means $16,643 for a single person and $22,412 for a family of two?"

If the opponents of the measure had convinced the Secretary of State to use language like "government-benefits," it could have influenced some people to vote no.

Voter-passed referenda are not binding in Maine, but if legislators do not try to amend the results, the governor cannot veto the measure. Given the fact that a majority of state legislators have repeatedly supported applying for the Medicaid expansion, if the referendum passes, it is likely to become law.

Amy Fried, a political science professor at the University of Maine, said she's hesitant to handicap the referendum's chances, since there has been no polling.

"You would not expect to see much turnout in such an off, off year," she said, adding that it's a challenge, perhaps, for either side, but probably more for supporters since Democrats tend to not have habitual voters.

But she noted, Maine does have centrist Republicans who support expansion, and national polls show strong support for Medicaid expansion.

That, and the fact that signatures were collected quickly, are "all signs there is weight of public opinion toward it," she said.

David Farmer, spokesman for Mainers for Healthcare, said he's not worried about the fact that November 2017 is an off-year election in Maine, when no statewide offices are on the ballot.

He feels like the failed push to repeal Obamacare in Congress fired up support for Medicaid.

"Voters, not just in Maine, but everywhere, want more health care coverage, not less," he said. He noted that people in the Bangor, Maine, airport applauded Republican Sen. Susan Collins when she returned from voting against a partial Obamacare repeal.

"We go into the November election with a lot of energy and a lot of support," he said.

Medicaid expansion is particularly important to rural hospitals in Maine.

There are about 263,000 people on Medicaid in Maine, and an expansion is expected to cover 70,000 more.

The Maine Hospital Association, which represents 38 hospitals, supports expanding Medicaid. Over the last five years, on average, 18 of Maine's hospitals have had negative margins.

Maine used to cover childless adults up to 125% of poverty with Medicaid, and when LePage rolled back that coverage in 2014, about 25,000 people were removed from the program. That expansion caused problems for the state budget, because there was not an enhanced match when it began. Medicaid was behind on paying hospitals, and ultimately, the hospitals received $490 million in back payments.

Maine won't receive the enhanced match for some of the expansion population because the state previously expanded Medicaid, then curtailed coverage. One of the earlier expansion efforts estimated the state would receive the regular federal match of about 62% for a quarter of approximately 79,000 eligible Mainers.