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Maine Medicaid expansion isn’t a sure deal
Maine’s expansion effort has already come under serious threat.
Maine became the first state to expand Medicaid with a ballot initiative late Tuesday night — but that effort has already come under serious threat.
The Medicaid expansion ballot passed by a double-digit margin, and would be expected to expand coverage to 70,000 to 89,000 low-income Maine residents.
This morning, however, Maine Gov. Paul LePage put out a statement saying he won’t implement the expansion until the legislature figures out a way to pay for it. This isn’t entirely unexpected: Maine will need to kick in a small sliver of the costs of the expansion. A state agency estimates that, once fully implemented, the Medicaid expansion will cost the state $54 million annually — but also bring in $525 million in federal dollars.
Maine still needs to figure out how to raise its share of the money; that wasn’t included in the ballot initiative that passed Tuesday night. And as Emma Sandoe has explained, “in Maine the governor has the ability to declare that there is not enough funding available and the initiative must go back to the legislature for approval within 45 days of the start of the session.”
LePage used his statement to denounce the Medicaid expansion, a program he has long criticized:
Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget. Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated, and I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.
Now, it is true that the Maine legislature has generally supported Medicaid expansion. It has passed five separate bills to enact the program. (LePage vetoed all of them.) So it’s possible the legislature will work quickly to figure out a financing plan to expand Medicaid.
But the current makeup of the Senate means there may be big road blocks ahead. A helpful reader points out that the current president of the Maine Senate is a Republican named Michael Thibodeau. Last June, he announced his run for governor to replace LePage in 2018.
Thibodeau has often been critical of previous Medicaid expansion efforts in Maine. He voted against the Medicaid expansion in 2013 and again in 2014. Here’s what he told the Portland Press-Herald in 2014, when he was running for office:
In the past two years, the Legislature has looked at nearly a half dozen proposals to expand this “free” health care yet again to mostly able-bodied Mainers who are capable of working. We simply cannot afford it. Moreover, the over-enrollment of this program has come at the cost of elderly Mainers and those with disabilities who remain on waiting lists for vital services.
It is possible there are enough moderate Republicans in the Maine legislature to overcome Thibodeau’s opposition to Medicaid expansion — but right now, it isn’t a sure thing. He does not appear to be a legislator who will make sure that funding comes through from the Maine legislature. If anything, his participation in the governor’s primary may pull him a bit to the right on the issue.
Utah will start collecting signatures for a Medicaid ballot later this month...
With the success of the Maine ballot initiative on Medicaid, I decided to check in with another state eying a similar effort: Utah.
A group of health advocacy groups, working under the umbrella of Utah Decides Healthcare, are working toward putting the expansion on their ballot next year.
“Poll after poll has shown support in Utah for covering this population,” says RyLee Curtis, a spokesperson for the group. “So we’re very excited and confident we can become the 34th state to expand Medicaid.”
The Utah groups will begin gathering signatures for their ballot on November 18. They’ll need to collect 113,000 signatures — the equivalent of 10 percent of the votes cast in each state Senate district during the 2016 election. They have until April to get it done.
Curtis pointed out one key difference between the Maine ballot initiative and the one they’re pushing in Utah: The Utah plan has a way to pay for expansion.
It proposes a small sales tax increase, which she says would work out to an additional 3 cents of tax on a $20 purchase of items, excluding food.
Including the tax hike in the ballot initiative does create some risk. It could turn voters off from supporting the initiative. Then again, it can also prevent the situation unfolding in Maine now — where a ballot passes and there isn’t a clear way for the state to pay its share of the costs.
“We wanted this to be as solid as possible,” Curtis says. “Our ballot is a full piece of legislation, where the Maine ballot was just about 50 words.”
...and Idaho also has a Medicaid ballot in the works
I also caught up with Luke Mayville, who is running the Reclaim Idaho effort, which is working to get a Medicaid expansion on the ballot in 2018, too.
The group needs to gather about 55,000 signatures spread out across the state — about 6 percent of voters in 18 different districts.
“We decided a month ago to go for it and file the ballot,” Mayville says. “Now we’re waiting for certification from the state attorney general, and we should have the petitions ready in early December.”
Mayville argues that the successful passage in Maine creates more momentum behind their effort.
“Ever since we declared our intention to put this on the ballot, we’ve heard a lot of doubt from some influential people here in Idaho,” he says. “Maine, we think, enables us to answer those doubts. It’s a rural, conservative-leaning state. And even though Idaho leans more conservative then Maine, we consider it highly significant that it won in Maine by almost 20 points. We have quite a bit of space there.”
Chart of the Day: High prices, not overuse, cause America’s high health care spending
It’s the prices, stupid. A very helpful graphic from the Commonwealth Fund is a great reminder of a fundamental truth in American medicine. We don’t spend more money because we go to the doctor a lot. We spend more money because, each time we go, our prices are hugely higher.
Kliff’s Notes
Your daily top health care reads, with research help from Caitlin Davis
News of the day
- “CBO says repealing Obamacare’s individual mandate penalties would save $338 billion”: “The Congressional Budget Office on Wednesday said that repealing Obamacare’s individual mandate penalties would save $338 billion over the next decade, providing a potential injection of money to help finance Republican tax reform efforts.” —Kimberly Leonard, Washington Examiner
- “Anti-abortion lawmakers push ‘Conscience Protection’ bill”: “Anti-abortion lawmakers in the House and Senate are pushing for language in the end-of-year spending bill that they say would protect health-care professionals who don’t want to take part in abortions because of their personal objections.” —Jessie Hellmann, the Hill
- “Humana to Cut 5.7% of Workforce Amid Uncertainty in Health Care”: “Humana Inc. said it would eliminate about 2,700 jobs, or 5.7 percent of its workforce, as it looks to rein in its costs amid wider shifts in the health-insurance business. The industry has been thrown into uncertainty by efforts to repeal or alter the Affordable Care Act.” —Marthe Fourcade and Natasha Rausch, Bloomberg
- “Feds say Ohio owes $29.5M for improper Medicaid bonuses”: “Federal investigators say Ohio owes the federal government $29.5 million for improper bonus payments rewarding the state’s effort to sign up children for Medicaid. Ohio received $64.5 million in bonus payments from 2010-13, but the U.S. Department of Health and Human Services Office of Inspector General says the state overstated its enrollment by including children that did not qualify.” —Jim Siegel, Columbus Dispatch
Analysis and longer reads
- “Healthcare Prices, Quality Information Remain Elusive In Most States”: “The move to require healthcare prices to be made public and inform patients about quality is going virtually nowhere in most U.S. states, a new report shows. This leaves most consumers lacking the “information they need to make informed healthcare choices” when such price and quality of care data isn’t provided, Altarum and Catalyst for Payment Reform say in their new analysis.” —Bruce Japsen, Forbes
- “Everything Trump Is Doing to Sabotage the Affordable Care Act”: “Among Donald Trump’s more pernicious and oft-repeated lies is that the Affordable Care Act (ACA) is imploding. It isn’t. But to the extent that problems are mounting, they are largely his doing.” —Joshua Holland, the Nation
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