AUGUSTA — Hours after a hotly debated Senate vote Wednesday on Medicaid expansion, hundreds of Mainers received automated telephone calls that could intensify the debate over expanding the public health insurance program to more than 60,000 uninsured residents.

In the computerized poll conducted Wednesday evening, participants were asked whether they would support expansion of Medicaid if they knew that nearly one in three people eligible for coverage are former prison inmates.

That and other negative assertions regarding Medicaid expansion raised questions about whether the survey was a push poll, designed to change public opinion rather than gauge it, and subject to the same campaign disclosure laws as political advertisements.

The calls also raised questions about who commissioned the poll, why, and whether its claim about prison inmates is accurate.

Wednesday’s vote in the Senate was a blow to backers of Medicaid expansion. The bill passed 22-13, leaving supporters two “yes” votes short of the two-thirds majority needed to override an expected veto by Gov. Paul LePage. The House could vote next week.

The poll was paid for by Action Point Campaigns, a consulting firm in Florida that has the same address as Strategic Advocacy, a political consulting firm that has operated in multiple Maine campaigns and is active in Florida.


Strategic Advocacy is run by Roy Lenardson, a 20-year veteran of Maine politics and an adjunct fellow for the Maine Heritage Policy Center, a conservative advocacy group that opposes the expansion of Medicaid. The firm has locations in Augusta and Ave Maria, Fla., a planned college community that is led by Tom Monaghan, a Roman Catholic philanthropist who founded Domino’s Pizza.

Strategic Advocacy is also affiliated with the Foundation of Government Accountability, a conservative advocacy group led by Tarren Bragdon, a former head of the Maine Heritage Policy Center. Both groups have vigorously opposed expansion of Medicaid in Maine and Florida.

Bragdon, who lives in Ave Maria and whom Lenardson describes as a close friend, was at the State House during the buildup to Wednesday’s Senate vote. His organization deployed a social media campaign last week opposing Medicaid expansion.

Lenardson confirmed Thursday that his firm was commissioned to conduct the poll, which he said reached 600 to 900 people. He would not say who commissioned it, citing client confidentiality.

Lenardson denied that the survey was a push poll, saying it was intended to determine how voters would respond to certain information or arguments.

“Basically, it’s typical message testing,” he said. He said the messages are no different from expansion advocates’ claims that 157 Mainers will die if the Legislature doesn’t vote to expand MaineCare, the state’s Medicaid program.


The Portland Press Herald obtained a partial audio clip of the poll. The questions were primarily about Medicaid expansion and support for Gov. Paul LePage, a staunch opponent of the proposal before the Legislature.

The survey began by asking respondents whom they favor in this year’s gubernatorial race: LePage, Democrat Mike Michaud or independent Eliot Cutler. It then described Medicaid expansion as providing health care coverage to thousands of “able-bodied” Mainers. It asked respondents if they would be more or less supportive of expansion if they knew that “almost one in three Mainers eligible for expansion are former prison inmates.”

The computerized caller also asked a series of questions about whether respondents would support expansion if they knew it would cause funding cuts to other state programs and veterans benefits; prolong the wait for severely disabled people who need additional Medicaid benefits; or increase health care costs.


Aside from the inmate question, several questions reflected familiar talking points of expansion opponents. Lenardson said that he didn’t know where the claim about inmates originated, and that his firm only edits questions for “grammatical errors, not content.”

An article published Sunday in The New York Times cited estimates by health care analysts and the U.S. Department of Justice that as many as 35 percent of the people who have gained eligibility for Medicaid under the Affordable Care Act have had contact with the criminal justice system. Those people were not necessarily incarcerated.


The Times also reported that states with expanded Medicaid eligibility are actively enrolling inmates.

Medicaid, in Maine and elsewhere, does not cover standard health care for inmates unless they’re hospitalized for more than 24 hours. Instead, states contract with private providers to give inmates care.

States that expand Medicaid will receive 100 percent federal reimbursement for inmates’ hospital visits of more than 24 hours until 2016. The reimbursement will gradually go down to 90 percent thereafter. Maine typically pays one-third of claim costs now.

National corrections officials – and people who testified in support of Maine’s expansion bill – say that enrolling inmates in Medicaid would allow them to have coverage when they get out. Proponents say that could mean fewer of them would end up back in prison or need hospital charity care.

Providing coverage for former prisoners is a positive result of Medicaid expansion, said Sara Gagne-Holmes, executive director of Maine Equal Justice Partners, an advocacy group for the poor and a supporter of expansion.

“(The poll) makes it sound like a negative, but providing these people care is a good thing and could save money,” she said.


In Arkansas a Medicaid feasbility study by the Alexander Group — the controversial firm contracted by Maine’s DHHS — found that the expansion would yield an annual savings in that state’s corrections budget of between $3.5 million and $4.5 million because of the increased federal match rate and other factors.

The Alexander Group did not conduct such a savings analysis in its Maine analysis for corrections, or any other program affected by expansion. 


Lenardson said he expects his client to publicize the poll results soon. If the message about Medicaid and prisoners polls well, it could become part of the debate as the House takes up the expansion bill next week. Or it could become a message in this year’s legislative and gubernatorial races.

The definition of a push poll varies, and Maine’s legal definition is narrower than guidelines endorsed by national polling experts.

State election law defines push polls as paid telephone surveys that refer to candidates or groups of candidates “other than in a basic preference question.” The definition does not include specific issues.


Other standards for a Maine push poll include failure to ask demographic questions about a respondent’s age, income or if they’re a likely voter – questions that don’t appear to have been asked in this week’s Medicaid survey.

Paul Lavin, assistant director of the Maine Commission on Governmental Ethics and Election Practices, listened to audio of the survey. He said it appeared that the survey was geared toward getting reaction to certain messages, but he acknowledged that it focused solely on presumed negative aspects of expansion.

The American Association for Public Opinion Research describes push polls as an “insidious form of negative campaigning, disguised as a political poll.”

It adds: “ ‘Push polls’ are not surveys at all, but rather unethical political telemarketing.”

Push polls often are done before elections and are designed to influence voters. However, they can sometimes be used by legislative leaders to influence votes among lawmakers, meaning the poll done Wednesday could be used to preserve Republican opposition to Medicaid expansion through upcoming votes in the House and Senate.

Steve Mistler can be contacted at 791-6345 or at:

Twitter: @stevemistler

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