Local Legislators Gear Up For Medicaid Expansion Battle

By Ruth Leubecker


Maine made history last week, becoming the first state in the nation to pass Medicaid expansion by citizen referendum. 

Gov. Paul LePage, who has vetoed Medicaid expansion five times, vows to stall this win at the polls by mandating the legislature to find the funding before he will allow implementation. 

The fight to give health-care coverage to over 70,000 uninsured Mainers has been a lengthy bitter battle, marked with heart-breaking stories and the fierce needs of many deprived daily of care.

“I think we’re going to handle it this time,” says Rep. Anne Perry of Calais. “The federal piece is still in place. These people who don’t have insurance are working. We need to remember that the people who have health insurance are more apt to do preventive care, and preventive health care costs us less.” Perry, a well-known nurse practitioner, is now semi-retired but still does home visits for many former patients unable to get care otherwise. She is also working to help ensure the survival of the Calais Regional Hospital. “I’m working with the hospital as best I can,” she said last weekend. “If rural hospitals close, costs go up. And when we have hospitals close, how do we get businesses to come here without access to health care?”

Maine’s care crisis continues to receive national attention. The New York Times last week informed readers, “Maine and other rural states face a health-care crisis that Medicaid expansion can’t fix on its own. It’s not about affordable coverage, but access. Under the Affordable Care Act hospitals are shutting down at an alarming rate.” Explanations for this include an increase in penalties for noncompliance with federal mandates, a tightening of reporting standards hiking the amount of paperwork involved and smaller reimbursements.

Maine has lost three hospitals, or 10 percent of its rural total, in the past seven years. This is an ominous outlook, considering that Maine has the highest percentage of rural residents in the country (New York Times, Nov. 9, 2017). Also according to the Times, the Calais hospital shut down its obstetrics department after pediatrics and its intensive care unit closed under pressure from Quorum, a Tennessee-based consultant group hired by Calais Regional Hospital. The Times article closed with what a big mistake it would be to expand health-care insurance, but offer no place to use it.

As rural facilities continue their individual struggles to keep their doors open, Medicaid expansion looms like the elephant in the room for the legislature. How to pay for it? How to wrest implementation from LePage? Potential questions and hazy answers cloud an already tumultuous situation. 

The cost of Medicaid expansion has been estimated at $54.5 million a year, with $27 million being saved from existing programs, and $500 million factored in from the federal government. It’s hard to reconcile these numbers, however, when LePage has said repeatedly that the cost will be $100 million annually.

“We’re going to have a tall task ahead of us in January,” says Rep. Will Tuell from East Machias. “My hope is that we won’t shortchange education, we can keep our promise to keep the prison (Downeast Correctional Facility) open, and we will not increase fees and taxes, especially on the fishing industry and mom-and-pop businesses.”

Tuell cautions that partisanship — all too often the case — will not solve anything. He has also said that before resorting to any of the above-mentioned potential cuts and taxes, he would be open to using the rainy day fund to finance Medicaid expansion.

“The only place I can see the money coming from is the rainy day fund,” says Rep. Robert Alley from Beals. “It’s definitely going to be a big thing. The referendum vote passed. But he refuses to sign it. I guess it’ll be a showdown.”

“I look forward to working with my fellow legislators to come up with a plan to fund (Medicaid) expansion,” says Sen. Joyce Maker. “We need to find the resources without raising taxes, cutting services to our most vulnerable or reducing our commitment to K-12 education.”