AUGUSTA — Maine Secretary of State Matthew Dunlap confirmed Tuesday that a campaign asking voters to approve an expansion of the state’s Medicaid system under the federal Affordable Care Act has submitted enough valid signatures to place the question on the November ballot.

The referendum effort to expand MaineCare, the state’s Medicaid program, is pushing forward even as President Trump and Republicans in Congress work to repeal the ACA, and as Maine Gov. Paul LePage, also a Republican, is pushing for additional cutbacks that would shrink MaineCare eligibility and reduce the amounts the state pays to reimburse hospitals providing services under MaineCare.

Approval of the MaineCare question submitted by Mainers for Health Care also comes as LePage and some Republican lawmakers debate whether the referendum process needs to be reformed, saying that recent questions approved at the polls subverted the legislative process and will harm the state’s economy.

In recent radio show appearances, LePage has been a particularly vocal critic, suggesting that voters didn’t know what they were voting for when they approved ballot questions that raised the minimum wage and tacked a 3 percent education-funding surcharge on the state’s income tax for households earning more than $200,000.

He and some Republican lawmakers say Maine’s constitution and laws allow out-of-state money to fund campaigns that mislead voters and drown out the voices of Maine residents.

“We need to reform the referendum process and we need to return to a representative government,” LePage said during his State of the State address on Feb. 7. “They are doing an end run around the Legislature by hijacking the citizens’ referendum process.”

If the MaineCare referendum is approved by voters, the Maine law would change the requirement for the state to provide federally approved Medicaid services through MaineCare to eligible individuals under age 65. The ballot question would set an income eligibility level for individuals with income equal to or less than 133 percent of the federal poverty level. For a family of four, that would mean an income of $32,252 or less.

At least two bills moving through the state Legislature also would expand MaineCare under the ACA.

LePage has successfully vetoed five bills passed by the Legislature to expand MaineCare.

The overall status of the ACA, also known as Obamacare, remains in doubt as Trump and Republicans in Congress have vowed to “repeal and replace” the federal law, which provides up to 90 percent in federal matching funds to states that expand their health care coverage for low-income residents.

PUSHING AHEAD DESPITE ACA THREAT

Robyn Merrill, executive director of Maine Equal Justice Partners and a spokeswoman for Mainers for Health Care, said if those bills are enacted into law, the group will work to pass the ballot question in November. Merrill said uncertainty over the fate of the ACA was certainly a factor, but until Congress acts, the option to expand coverage for Mainers under the current law is still in place.

“We don’t know what that’s going to look like,” Merrill said of any changes to the ACA. “What we do know is the option is there for Maine right now, and say there was a change at the federal level, and the voters pass this in November, it would come back to the Legislature, just as the Legislature is right now looking at referendums that passed in 2016.”

Merrill said lawmakers would then be faced with considering any federal changes and then “implementing the will of the people.”

Mainers for Health Care submitted 66,434 valid voter signatures, said Secretary of State Dunlap. That is more than enough to satisfy the threshold of 61,123 signatures for citizen ballot questions – or 10 percent of the total votes cast in the last gubernatorial election. In all, the campaign gathered 70,302 signatures on 2,670 different petitions, Dunlap said.

Also Tuesday, lawmakers on the Legislature’s Appropriations and Health and Human Services committees held a joint public hearing on LePage’s two-year state budget plan, considering portions of the proposal that would reduce state reimbursement rates to hospitals and reduce MaineCare eligibility for nearly 25,000 Mainers, including about 5,000 single adults ages 18 and 19. The eligibility changes alone would save the state about $140 million.

House Speaker Sara Gideon, D-Freeport, signaled Democrats’ opposition to the plan.

“Democrats will not sign off on a plan that would have such negative consequences in rural Maine,” Gideon said in a written statement. “Critical-access hospitals are already undergoing layoffs or facing closure. We need a transformational plan for Maine’s economy that involves pulling our state together, instead of deepening the divide between our rural and our urban areas.”

HOSPITALS SAY CUTS GO TOO FAR

Health and Human Services Commissioner Mary Mayhew spent over two hours answering questions from the committees while reviewing the budget proposals that would affect the delivery of health care in Maine and access to it by some of the state’s poorest citizens. Mayhew said LePage’s administration had increased Medicaid reimbursement rates by 30 percent, but at least one representative of Maine’s hospitals said Mayhew’s math was wrong.

The proposed rate reductions for hospitals, when fully implemented in 2019, would cost them nearly $66 million a year, said Jeff Austin, a top lobbyist for the Maine Hospital Association. Austin said the reductions, along with the reduction in MaineCare eligibility, would deal a devastating financial blow to Maine’s hospitals, most of which are already struggling financially.

“That is a staggering amount of cuts to ask our members to absorb,” Austin said. He said the $66 million figure did not include other parts of LePage’s budget proposal that could lead to hospitals and other large nonprofits like private colleges having to pay property taxes, from which they are currently exempt. Austin also said that every dollar the state saves in its Medicaid budget costs hospitals three dollars because every state dollar spent on Medicaid is matched by two federal dollars.

Neither Austin nor Katie Fullam Harris of MaineHealth would say the cuts would force some struggling hospitals, especially rural ones like Franklin Memorial Hospital in Farmington, to close their doors, but the service reductions would be severe if the cuts went through.

“Should you accept these budget proposals, it is going to be throwing gasoline on a fire that is already smoldering,” said Fullam Harris, a senior vice president of government relations for MaineHealth, an umbrella organization that includes eight regional not-for-profit health care systems, including Maine Medical Center in Portland. A chart she provided to the committees detailed the cost of the cuts at seven of MaineHealth’s hospitals or health care clinics – $38 million over the two-year budget cycle.

EFFECT ON OPIOID TREATMENT OPTIONS

The committees heard more than eight hours of testimony from a broad range of Mainers, including some in recovery from opiate addiction who said reducing access to health care for young people and the poor would exacerbate an ongoing drug epidemic that policymakers in Maine and nationwide have failed to halt.

“We must reduce barriers to much-needed health care resources, resources that are desperately needed amidst this historic period of record-shattering overdose deaths,” Andrew Kiezulas, a Portland resident and University of Southern Maine student, told the committees. Kiezulas, a recovering addict, said he was fortunate his family could spend thousands of dollars helping him get the treatment he needed, but that many Maine families simply don’t have the resources to pay for the cost of treatment for a loved one.

But Mayhew said many of the financial problems hospitals are facing are a result of reduction in federal Medicare reimbursement rates that also are part of the ACA.

“I obviously don’t believe we should be going backwards to the crisis management that long dominated the budget for the Department of Health and Human Services,” Mayhew said, reiterating the LePage administration’s stance of preserving health care benefits and programs for Maine’s neediest citizens, the elderly and the disabled.

“The opportunity to continue to build on this stable financial foundation is about acknowledging that we have a rapidly aging population in this state,” she said. Mayhew noted that pressures on resources to provide home-based health care and nursing home care for the elderly were only going to grow, and uncertainty over what would come of federal funding for health care under the new Republican administration in Washington meant Maine needed to shore up its DHHS budget even more.

“There are many pressures that continue to affect the MaineCare program,” Mayhew said. “We want to be prepared to thoughtfully respond to those pressures.”

The committees will continue to break down the DHHS portions of LePage’s $6.8 billion budget proposal in joint hearings Wednesday when they take up proposals to reduce costs in the state’s Temporary Assistance to Needy Families program and an elimination of state funding for General Assistance, an emergency benefits program administered by Maine cities and towns.

Scott Thistle can be contacted at 791-6330 or at:

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