Douglas Rooks

Douglas Rooks

The first two questions on Maine’s Nov. 7 ballot could not present a greater contrast. The first is a frivolous attempt to enrich a particular casino developer; the second is essential to life itself.

Question 2, which would make Maine the 32nd state to accept federal funding for the Affordable Care Act’s expanded Medicaid program, is both long overdue and extraordinarily timely.

Most states have been receiving funding for four years, aiding millions of poor and near-poor Americans, while in Maine strong majority votes in the Legislature have been cancelled by Gov. Paul LePage’s vetoes. Adding insult to injury, LePage has shown through his public statements that he doesn’t even understand the program he so cavalierly denies his fellow Mainers.

LePage is also responsible for a 2012 budget maneuver that removed 28,000 Mainers from Maine Care coverage even before expansion took effect. Added to the 70,000 who could have benefited since 2014, the governor has denied 100,000 people access to reliable health care – perhaps the most staggeringly irresponsible part of his legacy.

Some referendum questions, such as Question 1, clearly do not belong on the ballot. Question 2, however, is something that should have been tried sooner, rather than waiting for LePage to leave office.

Medicaid expansion is also timely, because the Republican effort to repeal the Affordable Care Act has collapsed, and will not be renewed. At the simplest level, repeal failed because a few Republican senators, including Maine’s Susan Collins, opposed it.

In a larger sense, though, it was greater public understanding of the Medicaid program that turned the tide.

At first, Republicans bent on repeal used the same arguments LePage had in opposing implementation back in 2013 – that Medicaid is “welfare,” and it’s unfair to the “hardworking Americans” who have to find health insurance on their own.

The argument is fallacious on several fronts. First, most of those newly eligible for Medicaid are working – they just don’t make enough money to afford insurance, even as subsidized by the ACA exchanges.

The second fallacy is that Medicaid is a “Cadillac” health care plan. A relatively sympathetic account in The New Yorker recently claimed Medicaid has “no premiums, no deductibles, no co-pays, no costs at all” – coverage other working families “couldn’t dream of.”

This account bears no resemblance to how Medicaid works. It provides the lowest provider reimbursements of any program – private insurance, Medicare, the VA – and many practices accept few Medicaid patients, or none.

In Canada, Britain or France, these rates might cover all the care needed, but in our hopelessly overpriced health care system, it keeps many patients from seeing a doctor. That’s the grim reality.

Medicaid is basic care. Many services those privately insured see as essential aren’t required by federal rules, and many states exclude them. The “crowding out” from Medicaid coverage so beloved of conservative think tanks is largely an illusion.

Despite all the attempts to undermine support, Medicaid has risen to the top of the reasons why most Americans don’t want the ACA to go away. When it comes to either providing health care access, or denying it on the grounds it’s “government health care” that “we can’t afford,” public opinion has moved decisively toward access.

Question 2 is both a political statement, and a moral one. Politically, it means we no longer think it’s a good idea, or necessary, to deny a large proportion of Americans basic health care. Universal coverage is still far off, but the public understands it’s a necessary first step toward fixing the system.

Morally, we’ve decided that we are our brother’s keeper. Charitable efforts are a vital part of providing assistance to the poor, the disabled and all those who can’t fully support themselves through employment or other income. Yet there are basic standards of care all should have, simply by being members of a society with means to provide it.

We’ve turned a corner in our understanding of what, as in every other developed nation, it means to be a citizen. A strong vote for Question 2 will affirm that conviction.

That will not be the end; the governor and his allies will resist implementing a successful referendum vote, as they did on other questions from the 2016 ballot. But this one is different.

The nation is watching, and a collective voice calling for a more just society will not easily be disregarded. We’re moving beyond a debate over whether health care is a “right” or a “privilege” – and beginning to realize it’s a necessity.

Douglas Rooks has covered the State House for 33 years. His biography, Statesman: George Mitchell and the Art of the Possible, is now available. Comment is welcomed at [email protected]

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