When Maine voters overwhelmingly said “yes” to Medicaid expansion Tuesday, Luke Mayville was closely tracking the results from 2,900 miles away in Moscow, Idaho.

“We were eagerly awaiting Maine’s vote,” said Mayville, co-founder of Reclaim Idaho, a grassroots group that’s attempting to get Medicaid expansion on Idaho’s statewide ballot in 2018. “We see the campaign in Maine as something to emulate.”

Maine became the first state in the nation to approve Medicaid expansion by referendum, making an estimated 70,000 low-income Mainers eligible for Medicaid.

Mayville said the margin of victory – 59 percent to 41 percent – is providing momentum for the effort in Idaho, considered a much more conservative state.

“The win was nearly 20 points. We don’t have to win by 20. If you win by 5 that’s still a win,” Mayville said. “The Maine vote is the best support yet for our argument. It didn’t just win. It won by a landslide.”



The Maine vote was closely watched both in Idaho and across the country as an indicator of what could happen to Medicaid expansion efforts in other states. The national media highlighted the Maine vote in the run-up to the election – including stories by The New York Times and The Wall Street Journal – at a time when President Trump and congressional Republicans were working to repeal or undermine the Affordable Care Act, which subsidizes Medicaid expansion.

With Tuesday’s vote, Maine will become the 32nd state to expand Medicaid – although Gov. Paul LePage is trying to block implementation. Other states considering expansion ballot initiatives include Utah and Kansas.

States that choose to go the referendum route could see an infusion of out-of-state political money, as happened in Maine. The “yes” campaign in Maine benefited from an outpouring of funds from progressive groups.

Washington, D.C.-based The Fairness Project, a liberal advocacy group, contributed about $700,000 to the $2 million Mainers for Health Care campaign. Another Washington liberal advocacy group, the Sixteen Thirty Fund, pitched in $600,000, according to campaign filings with the Maine Commission on Governmental Ethics and Election Practices.

Jonathan Schleifer, executive director of The Fairness Project, said the group’s experience working on the Maine minimum wage campaign in 2016 propelled it to get involved in Medicaid expansion. Maine voters approved a $12 minimum wage a year ago.

The Fairness Project, which has a $2.8 million operating budget, was launched two years ago and is primarily funded by a California public employees union and Dr. Bronner’s, a California company known for making soap.


In an interview Wednesday with the Portland Press Herald, Schleifer said he was in Maine on Saturday through Tuesday to help knock on doors, organize and attend the election night party at the Bayside Bowl in Portland.

“What Maine did was historic,” he said.

He said that when Mainers for Health Care reached out to him this year to work on Medicaid expansion, “we didn’t hesitate.”

“We were so impressed with the grassroots infrastructure they had in Maine from the minimum wage campaign that when they said they had a plan to expand Medicaid and would we back them, we said ‘Absolutely,’ ” Schleifer said.


David Farmer, spokesman for Mainers for Health Care, said national progressive organizations support statewide ballot initiatives that they believe will succeed, and for issues that “matter in people’s lives.” Increasingly, states that allow citizen referendums are seeing more of them when issues stall out in the Legislature. LePage vetoed Medicaid expansion five times.


Diane Rowland, executive vice president of the Kaiser Family Foundation, said she sees the Maine results reverberating across the nation, spurring other states to try it.

“A lot of people were looking at Maine to see what the results would be,” she said. “If Maine had success, it would give them the impetus to do it. They have a victory to talk about now.”

Once Medicaid expansion is implemented, Mainers who are jobless or earn up to 138 percent of the federal poverty level will be eligible for the free insurance. The Affordable Care Act made Medicaid expansion attractive to states by funding 90 percent or more of the cost of expansion.

For Maine, that means spending about $54 million in state money annually and receiving $525 million per year in federal money. The funding is expected to boost rural hospitals, expand treatment options for substance use recovery and mental health programs, and create jobs in the health field. States that have expanded Medicaid have experienced a bigger drop in the uninsured rate when compared with non-expansion states, the Kaiser Family Foundation said.


The vote in favor of expansion was widespread, as voters in rural, suburban and urban Maine supported the referendum.


Brian Duff, associate professor of political science at the University of New England, said Maine is a “moderate” state, so for the electorate to approve the expansion by a big margin shows a “shift in thinking” about health care. Duff said rural communities may see how Medicaid expansion could benefit the population and the workforce by protecting jobs and services at rural hospitals.

“Medicaid helps the working poor, and generally in America there’s a lot of respect for the working poor,” Duff said. “These are people who are out there hustling at their jobs.”

The expansion will come after a major contraction in Maine’s Medicaid population, caused in part by the LePage administration’s tightening of eligibility requirements. About 265,000 Mainers currently have Medicaid. The LePage administration’s Medicaid cutbacks resulted in about 36,000 Mainers losing Medicaid, including childless adults and some low-income parents.

Mitchell Stein, a Maine-based health policy expert, said the Maine vote likely will have national ramifications. Not only could other states adopt expansion, but the ACA is more likely to survive future repeal attempts now that there’s evidence of how much support it has at the polls, Stein said.

“I think the vote ultimately shows that people are decent, and that people are interested in healing their neighbors,” he said.

Joe Lawlor can be contacted at 791-6376 or at:


Twitter: joelawlorph

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