Douglas Rooks

Douglas Rooks

The governor’s race this year is about many things.

It’s about Gov. Paul LePage’s management of state government. It’s about energy policy, and stark differences between LePage and his two rivals, Mike Michaud and Eliot Cutler. And it’s about who’d be able to govern with the Legislature and not against it.

But of all the issues, one stands out. Will Maine allow all its citizens access to health care, or will it continue to deny them?

There is no other area where the differences between the candidates are so stark, or the results for public policy so consequential.

As usual with important issues, Michaud and Cutler are on one side of the fence and LePage on the other. The governor continues to insist Maine must not accept 100 percent federal funding for Medicaid — MaineCare — even though he’s never come up with even a plausible reason for doing so.

LePage has vetoed five different bills that would have expanded Medicaid, even some proposed by Republicans, and insists it’s all about handing things to people who don’t deserve it.

This runs directly counter to the promise of the Affordable Care Act (ACA), which people are finally beginning to understand now that we’re nine months into implementation.

Every American, without exception, is supposed to have access to affordable coverage, either through the private insurance exchange, which offers subsidies based on income, or through the three government programs. Those are the VA for veterans, Medicare for seniors, and Medicaid for lowincome families.

In the ACA enacted by Congress and signed by President Obama, the Medicaid expansion wasn’t optional. But though he voted to uphold the law in a 5-4 ruling, Chief Justice John Roberts also decided states couldn’t be “forced” to cover more people with Medicaid.

He made that decision even though “traditional” Medicaid requires 50 percent funding by many states — Maine gets a higher match because of its lower per capita incomes — and “expanded” Medicaid is covered for three years with 100 percent federal funding, and permanently at 90 percent.

Yet because LePage, and many other Republican governors, refused to accept expanded Medicaid, only 26 states implemented it, though more are now doing so.

The initial results are now in.

Maine was one of only two states that in 2013 saw its uninsured rate increase, along with New Jersey. This was before the Medicaid expansion took place in January 2014.

The unmistakable reason for the jump, from 10.2 percent to 11.2 percent of the population, was LePage’s insistence that 28,000 people who’d been eligible for Medicaid since 2004 be cut off. He implemented that decision through a 2012 supplemental budget passed by majority vote when Republicans briefly controlled the Legislature. It came after the two-thirds biennial budget was passed the previous year with the understanding no more health care cuts would be made.

Economic figures for this year show that, in addition to creating more uninsured Mainers, LePage’s policies have depressed job growth. The nation has recovered 102 percent of jobs lost in the Great Recession, and New England as a whole, 128 percent. Maine has recovered only half its lost jobs.

Health care employment wouldn’t make up the entire gap, but the 4,000 jobs created by a Medicaid expansion would certainly come in handy.

Hospitals are hurting, in particular. LePage takes credit for paying past charges to hospitals by tapping a new 10-year state liquor contract. What he fails to acknowledge is that by denying the hospitals $350 million in annual, ongoing federal funding from Medicaid, he’s setting them up for future failure.

Already, the strain is showing. Franklin Memorial Hospital in Farmington, a model rural provider, decided it can’t afford to continue independent operations, and merged with Maine Health in Portland. We can expect more such mergers and downsizings as long as LePage’s Medicaid policy remains in effect.

So voters have a choice: Continue to damage the Maine economy and deny Mainers basic health care, or elect a new governor. It’s that simple. It’s clear LePage will continue to veto any Medicaid expansion plan, and equally clear Democrats have no realistic chance of controlling both House and Senate by the two-thirds majorities needed to override.

Either Cutler or Michaud would accept federal Medicaid dollars in an instant, though with Cutler bumping along in a distant third place, Michaud is the only candidate we can expect to change things.

Normally, single-issue voting doesn’t have much to recommend it. This year, however, it makes perfect sense, both to restore fiscal sanity and rectify a tragic public policy mistake.


Douglas Rooks is a former daily and weekly newspaper editor who has covered the State House for 29 years. He can be reached at [email protected]

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