Maine Voters First In Nation To Expand Medicaid Coverage Via Referendum

Nov 7, 2017

Voters overwhelmingly approved Question 2, which will extend Medicaid coverage under the Affordable Care Act to more than 70,000 people.

Maine is the first state to expand Medicaid through a citizen’s initiative, and supporters say it sends a message to the country that more people need affordable health coverage.

It’s a long-awaited victory for supporters of Medicaid expansion, who have watched the Legislature enact bills to expand the insurance program over the past several years, only to be vetoed by Gov. Paul LePage five times. That’s what prompted Robyn Merrill, the executive director of Maine Equal Justice Partners, to take the matter to the ballot box — and the strategy worked.

Merrill and Question 2 supporters could barely contain their excitement for the victory, and for the history Maine made on Tuesday as the first state to expand Medicaid through a citizen’s initiative.

“Maine is sending a strong and weighty message to politicians in Augusta and across the country. We need more affordable health care, not less,” she said.

Maine will now join the 31 states that have already expanded Medicaid to cover adults with incomes up to 138 percent of the federal poverty level. That’s about $16,000 for an individual and $34,000 for a family of four. Currently, people within that income bracket fall into a coverage gap created when the Supreme Court made Medicaid expansion under the Affordable Care Act optional — earning too much to qualify for subsidies under the ACA and too little to afford insurance on their own.

“Finally, maybe people now people like myself can get the health care we need,” said Kathleen Phelps, a hairdresser from Waterville who fell into the coverage gap.

Phelps lost her Medicaid coverage four years ago and said she has had to go without the medication and oxygen she needs for her emphysema and COPD. But because of Maine voters, she said, she’ll get it back.

“I will have oxygen back in my home, and I’ll sleep good at night,” she said.

The passage of Question 2 is also a win for the state’s hospitals. More than half are in the red, according to the Maine Hospital Association.

Association Spokesman Jeff Austin said hospitals also provide more than $100 million a year in charity care. Expanding coverage will restore some fiscal health to hospitals, he said, and give doctors and nurses more options to treat their formerly uninsured patients.

“There are just avenues of care that open up when you see a patient, from recommending a prescription drug or seeing a counselor. Doors that were closed previously will now be open,” he said.

The federal government will kick in 94 percent of the cost of Medicaid expansion in 2018. That lowers to 90 percent by 2020. The state Office of Fiscal and Program Review estimates that will bring in $500 million from the federal government per year — a deal that Question 2 supporters say Maine couldn’t refuse.

But opponents, including Brent Littlefield of the Welfare to Work PAC, point to the state cost, which is projected to be about $50 million a year.

“The Legislature has to somehow come up with the money for this large government expansion, and there is no money there to pay for that. So now the Legislature has to ask themselves, ‘How do we pay for this?’ And that is likely to result in cuts, or likely a push for tax increases,” he says.

Medicaid expansion will now be in the hands of the Legislature, which changed, delayed or overturned four ballot initiatives that Maine voters passed last year. But Merrill says she’s confident that lawmakers will implement Medicaid expansion quickly. After all, she says, they’ve passed it five times before.