Editorial: Healthcare referendum on the chopping block

Question 2 for Maine’s 2017 referendum voting was posed to decide on Affordable Care Act (ACA) expansion efforts for the state. More than 200,000 Maine voters approved the expansions, making up 59 percent of voters giving the green light to the referendum. While Maine is the 32nd state in the country to approve ACA expansions, it is the first to do so by referendum vote — an action necessitated by five consecutive vetoes of the expansion by Governor Paul LePage.

LePage’s concerns lie in funding and efficiency — two points which several individuals and organizations have called insufficient arguments against this ACA expansion. LePage published an official statement on Nov. 8, the day after the vote. The report referenced the last expansion of Medicaid in 2002 as a reason for blocking the ACA expansion. It further suggested that the voter-approved expansion would cost Maine egregious amounts of money to run.

However, the expansion would not be left for Mainers alone to cover. The federal government would cover 94 percent of costs in 2018, and 90 percent after 2020. Bustle reported that, “the remaining 10 percent still leaves about $54 million that Maine would have to pay each year,” after the drop to 90 percent covered federally. Other states that have approved expansion have covered these gaps with taxes to providers.

Proponents of expansions often cite the moral imperative of providing basic healthcare for everyone in Maine. This expansion would provide coverage to an estimated 70,000 to 80,000 people — each of them equally deserving of healthcare protections. These people have fallen into the coverage gap created in shifting national healthcare decisions. They make too much money to fit into subsidies, but can’t afford private insurance.  

Comparisons to the 2002 expansion are misguided and only work to cloud judgment of this year’s proposed changes. An expansion done 15 years ago has only scant similarities to ACA expansions now. Their funding is different, and healthcare realities have changed since 2002. How long do we use the excuse of one past expansion to stop all others?

The Press Herald decided in an opinion piece that the expansion would benefit everyone in Maine, writing that, “doctors, nurses, and hospitals already provide care to the uninsured and underinsured, and everyone benefits when this coverage is compensated.” These sentiments were shared by others. State Sen. Troy Jackson issued a statement about LePage’s response, claiming that, “Mainers passed Question 2 because they want more health care, not less. They want to give our state the tools we need to fight the opioid epidemic, to keep critical rural hospitals open for business and to create sorely needed jobs.”

The opioid crisis is a growing problem nationally and impacts people in Maine — many of which could be reached with treatment methods under this ACA expansion. The Kaiser Family Foundation addressed Medicaid’s role in the opioid crisis this September, citing it as “a key tool to fight against the epidemic,” covering treatment and hospitalizations. Other measures to counter the epidemic have been vetoed by LePage as well, which leaves Maine at a standstill with addressing the problem.

Since LePage has vetoed Medicaid expansions five times, and is working on a sixth time, we have to ask ourselves at what point are the people of Maine heard? If referendum results are blocked, there seems to be little point in spending time and resources on casting votes. In refusing to make changes to our healthcare in Maine, people are falling between the cracks with no hope of rising. Belief in the good of a democratic system is threatened when thousands of Mainers say yes, and the one representing them gives an uncompromising no.