In early November, Maine citizens voted to expand Medicaid under the Affordable Care Act. According to a New York Times election poll, Maine is the first state in the country to solve the Medicaid question via a referendum. Though 58.9 percent of the state voted in favor of expansion of access, Governor Paul LePage has stated that he will not implement the expansion.
As of mid-November, LePage has vetoed Medicaid expansion bills five times. Finances are a major concern, because the federal government will not fund it entirely. During the January session, Maine legislators will have to create a new budget to cover the cost of Medicaid coverage for 80,000 people. A recent Politico article cited Maine’s health agency, who said that by 2020, expansion of Medicaid will likely cost the state $97 million.
Until 2016, the federal government fronted the cost under the Affordable Care Act, colloquially known as Obamacare. Over time, however, state governments will have to pay higher percentages of the cost, starting with five percent and moving up incrementally to 10 percent over the next two years. Because of the high cost, LePage is hesitant to implement the expansion, even though the majority of Maine voters are in favor.
In January 2017, the American Academy of Pediatrics released a report that said children make up 40.9 percent of Maine’s Medicaid population, or 114,000 children. Medicaid costs just over $3,500 per child each year, and just over $5,400 per adult. The report also highlighted the loss of federal funding for cutting state funding — for every $1 Maine removes from the state Medicaid budget, it loses $1.81 in federal funds.
Most states, according to the Kaiser Family Foundation’s annual Medicaid budget survey, use general state funds to cover expansion costs, and some tax health care providers. Maine has until fiscal year 2019 to finalize state funding.
In 2016, the Bangor Daily News published an article regarding the laws surrounding referendums. Referendums passed in November go into effect in January, but the legislature can propose and vote on amendments after the fact. LePage has a history of altering referendums, including last year’s marijuana legalization. Though there is pushback, the state government legally can make changes.
However, Maine has no laws regarding how soon an issue can appear on the ballot again, so if a referendum is changed too much or is vetoed, it can be voted on again the following year. While LePage has stated that he will not allow this to be implemented, his vocal opposition to the expansion of Medicaid is currently based in financial considerations. It is likely that by the time the budget has to be finalized, legislators’ fears will be quelled.