Will Maine’s Medicaid Expansion Happen? Governor Paul LePage Isn’t On Board Yet

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Gov. Paul LePage has announced that he will attempt to obstruct the Medicaid expansion that Maine voters approved by an 18-point margin on Tuesday. "My administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated," the state's governor said in a statement released Wednesday.

Around 268,000 Maine citizens currently get their health care coverage from Medicaid. The expansion they voted for would make the program available to anyone with an income of up to 138 percent of the federal poverty level, which would make an additional 70,000 people eligible.

Section 19 of the Maine Constitution makes it clear that governors may not single-handedly veto a resolution passed by the people, and that the measure should take effect within 30 days. There are some loopholes, though: If the governor and legislature both veto it, the bill must go up for a vote again during the following general election. And the implementation timeline can be delayed if the government has to appropriate new funds to pay for the measure (and it does, for this bill), in which case it won't become law until 45 days after the legislature next convenes.

Gov. LePage may also try to change the bill — the legislature is entitled to make revisions — or just refuse to appropriate the funds.

"He may put the state in default to the federal government," Professor Orlando Delogu from the University of Maine School of Law told Slate. "He will not go quietly into becoming the 32nd state to participate in the Medicaid expansion."

Opponents of the referendum argued that it would take resources away from other valuable state programs. While 90 percent of the expansion would be funded by the federal government, the remaining 10 percent still leaves about $54 million that Maine would have to pay each year.

"The last time Maine experimented with Medicaid expansion in 2002 under then-governor Angus King, it created a $750 million debt to hospitals, resulted in massive budget shortfalls every year, did not reduce emergency room use, did not reduce the number of uninsured Mainers and took resources away from our most vulnerable residents — the elderly and the intellectually and physically disabled," Gov. LePage said on Wednesday. "I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled."

Gov. LePage is a Republican presiding over a mixed legislature in which Democrats control the House of Representatives and Republicans hold a one-member majority in the Senate. Maine is a swing state but tends to lean liberal, which has created tension between LePage and legislators since he assumed office in 2011.

By May 2016, he had vetoed over 450 bills; he has specifically vetoed Medicaid expansion five times. His unwillingness to broaden the program is what caused nonprofit group Maine Equal Justice Partners to bring the issue directly to voters with a referendum.

"It’s the law now. The administration needs to implement it," Robyn Merrill, executive director of the organization, told the Portland Press Herald. "If they fail to do that, there would be legal recourses."

"Democrats will not give an inch in this fight because it is a matter of life and death," Democratic State Senator Troy Jackson said in a statement. "We will give no quarter to anyone who tries to take health care away from those hardworking Mainers who have been allowed to fall through the cracks for too long."

Since becoming governor, LePage has opposed the expansion of Maine's Temporary Assistance for Needy Families program, made efforts to loosen child labor restrictions, and tried to prevent Syrian refugees from resettling in his state. On Friday he vetoed a bill to legalize recreational weed that voters approved last year, and on Monday the House of Representatives sustained that veto.