In July, Maine’s government endured its first shutdown since 1991. It was the product of a combative legislative session where lawmakers spent most of their time squabbling over the four ballot questions approved by Maine voters in November 2016.

Essentially, the shutdown came down to $162 million in additional funding for public schools. Now that this funding has made it into the biennial budget, it’s safe to say that Mainers will be on the hook for this cash every two years when the legislature is required to pass a budget. This could lead to further disputes down the road, especially if Mainers continue to pass costly and consequential initiatives at the ballot box.

Unfortunately, this November’s ballot features another referendum that will hurt the Maine people and force our lawmakers into even more contentious budget negotiations down the road.

On Nov. 7, Maine voters will choose whether to expand Medicaid eligibility to able-bodied, childless adults between the ages of 21 and 64 who earn up to 138 percent of the federal poverty level (FPL). The measure also extends Medicaid eligibility to noncitizens 21 and under.

To date, 31 other states and the District of Columbia have expanded Medicaid eligibility under the Affordable Care Act, or Obamacare. Thankfully, the experiences of these states, coupled with Maine’s dysfunctional experiment with Medicaid expansion in 2002, gives us a wealth of data to determine the ramifications of expansion in 2017.

When Maine expanded in 2002 under Gov. Angus King, proponents claimed that expansion would provide a “huge boost” to Maine’s economy, reduce the uninsured rate, curb uncompensated care at Maine hospitals, save lives and enroll only an additional 11,000 Mainers into the program. Not even one of these claims turned out to be true, yet they are the same talking points used to push expansion today.


Expansion provided no boost to Maine’s economy. In the three years prior to expansion, Maine’s average annual GDP growth was about 6 percent. In the three following years, this rate shrunk by nearly one-third. Maine’s uninsured rate did not decline after expansion either. In fact, all expansion did was transition the privately insured onto government-subsidized health insurance. This is called “crowd out,” a phenomenon characterized by the privately insured switching to public plans once the eligibility criteria for government health programs are expanded.

Between 2002 and 2010, the share of Mainers with employer-sponsored health insurance fell from 70 percent to 61, and the share enrolled in Medicaid grew from 14 to 25 percent. During this time frame, the uninsured rate in Maine remained around 12 percent, showing that expansion resulted only in taxpayers footing the bill for healthy people to receive government subsidized health care.

Because the number of uninsured Mainers remained unchanged, there was no reduction in uncompensated care, or charity care, at Maine hospitals. In 2002, Maine hospitals delivered roughly $50 million in uncompensated care. By 2011, charity care in Maine had climbed to nearly $200 million annually. Additionally, Medicaid expansion does not save lives. This is a crude and unscientific assertion made by proponents of expansion. A comparison of mortality rates in expansion and non-expansion states since 2014 shows that expansion states saw higher age-adjusted mortality rates than non-expansion states.

Finally, the 2002 estimate of 11,000 new enrollees was blown out of the water. Medicaid enrollment grew to 17,000 within 14 months of expansion, and the program had to be capped once enrollment hit 25,000. Today, proponents assert only 70,000 Mainers would be covered, but Census Bureau data shows there are 144,000 eligible Mainers. Further, there are about 80,000 who earn just above 138 percent FPL with new incentive to limit their earnings in order to obtain coverage.

These low estimates lead to massive cost overruns, which are seen almost universally in expansion states. When cost overruns occur, lawmakers are forced to find places in the budget where they can cut services. Several states that have expanded Medicaid have already cut services for traditional Medicaid enrollees because the federal government provides more assistance for expansion than it does for the traditional Medicaid program. In other words, there’s a perverse incentive for lawmakers to cut traditional Medicaid funding because Maine would save 26 cents more on every dollar cut from the traditional program opposed to expansion.

If voters pass this measure in November, it’s only a matter of time until Maine’s truly vulnerable citizens – low-income children, pregnant women, and the disabled – see their benefits cut as lawmakers struggle to secure funding for the bloated costs of expansion.


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