Gov. LePage likes to catch people off-guard – just look at the ambitious tax reform package that he unveiled last month.

The governor has a chance to really surprise people at his State of the State address Tuesday if he’d come out for expanding MaineCare eligibility to comply with the Affordable Care Act. LePage made refusing the $1 million a day in federal funds – and all the obligations that would come with it – a centerpiece of his re-election campaign. But changing course on this issue is not as far-fetched as it sounds.

Republican governors in Tennessee, Utah, Wyoming and now Indiana have proposed ways that their states can offer federally supported private health insurance to people who earn as much as 133 percent of the federal poverty level – $15,000 for an individual and $26,000 for a family of three.

They are all using some variation on redirecting federal funds earmarked for expanding Medicaid to buy insurance on the exchange and help recipients pay out-of-pocket costs. It’s not as comprehensive as Medicaid coverage, but for the state’s uninsured, it would be a big improvement. Like those other Republican governors, LePage could work to find a compromise Medicaid expansion that would increase access, decrease free care and make the whole system more efficient.

PROGRESS, BUT COULD BE BETTER

LePage addresses the state Tuesday at a time when there is good news in Maine regarding individuals buying health insurance in the federal marketplace known as the exchange.

According to the Henry J. Kaiser Family Foundation, Maine is among the top states when it comes to signing up individuals who are eligible for the program. Maine has enrolled roughly half of the 124,000 potentially eligible residents, and there are still almost two weeks to go in this enrollment period.

But the number of uninsured Mainers could have been cut to near zero if the state had accepted Medicaid expansion. Some of the people who have been left uninsured may be able to afford subsidized insurance on the exchange without any help, but by any reckoning, there will be tens of thousands of Mainers who will not have coverage for preventive care or a catastrophic illness.

Who are the uninsured? The group includes an estimated 22,000 childless adults with incomes below the federal poverty level, which is less than $11,600 a year. These people cannot buy insurance on the exchange because the law was written assuming they would become Medicaid-eligible. They are left making do with either emergency free care or no care at all.

PUTTING OFF CARE UNTIL ILLNESS

Most of the others are people who work in jobs that don’t offer an insurance benefit and don’t pay enough for them to buy coverage on their own. These low-wage workers are likely to put off care until they are so sick that they have no choice.

The other group that needs the governor and Legislature to find a way to get more Mainers covered is the state’s hospitals, which are seeing a spike in both bad debt and demand for free care. The Maine Hospital Association reports that those costs have tripled over the last five years, to $13.6 million last year.

The arguments for Medicaid expansion have been made again and again over the past two years, and the issue was heavily debated in the recent election – which Gov. LePage and many Republican legislators won, promising not to accept the money. But what’s changed is that the federal government has shown a willingness to compromise with states that want to expand coverage without expanding the Medicaid commitment.

Maine could be the next state on that list if Gov. LePage is ready to spring another surprise Tuesday.