WESTBROOK — The political debate over Medicaid expansion in Maine continued Thursday, with Attorney General Janet Mills and Washington Gov. Jay Inslee slamming Gov. Paul LePage for continuing to block expansion despite voter approval.

LePage, meanwhile, vowed this week that he’d risk jail time before he’d allow “red ink” in Maine’s finances as he battles with lawmakers over funding for Medicaid expansion.

“The one thing I know is nobody can force me to put the state in red ink and I will not do that,” the Republican said in a radio interview. “I will go to jail before I put the state in red ink. And if the court tells me I have to do it, then we’re going to be going to jail.”

Inslee appeared alongside Mills – the Democratic nominee for governor – in his capacity as chairman of the Democratic Governors Association and said that Medicaid expansion was part of Washington state’s “robust, consistent and comprehensive success” in reforming health care.

The Democrat said Medicaid expansion provided health coverage to an estimated 600,000 additional adults, helped about 20,000 individuals obtain opioid addiction treatment and sparked the creation of thousands of jobs. At the same time, expansion has reduced costs by reducing emergency room visits by the uninsured and likely reduced long-term costs by guiding people into preventive care, he said.

“It is absolutely nuts not to accept free money to help this effort when people need health care,” Inslee said. “There is no explanation for that except this: rigid ideology. And that rigid ideology is itself a health care menace in the state of Maine.”

MOODY OPPOSES EXPANSION

Last fall, nearly three out of five voters supported expanding Medicaid to between 70,000 and 80,000 Mainers by July 2, making Maine the first state to vote at the ballot box in favor of expanding the health insurance program for low-income people. Expansion would open the program to Mainers who earn up to 138 percent of the federal poverty level, which is annual income of $16,753 for an individual and $34,638 for a family of four.

Mills also pointed to the federal government’s current 9-to-1 match on expansion costs, comparing LePage’s position to turning away a company pledging to spend $500 million in return for a 10 percent state match.

“That’s why I pledge to the people of Maine here and now that if Medicaid expansion is not implemented by the time I am governor in January, and I hope it is, I will act on day one to see that it is done,” Mills said.

Three of the four candidates for governor – Mills and independents Terry Hayes and Alan Caron – support Medicaid expansion, while Republican Shawn Moody opposes it.

In a statement released before Mills’ appearance with Inslee, Moody campaign spokeswoman Lauren LePage made clear that the Gorham businessman is on the same page as her father the governor.

“As governor, Shawn Moody will enforce the laws on the books, with appropriate funding from the Legislature who under the constitution must pass all spending bills,” Lauren LePage said. “Shawn will not risk the fiscal health of the state to expand welfare for non-disabled individuals, and will not support funding welfare by raising taxes, raiding the rainy day fund or using one-time budget gimmicks. It is not surprising that a career politician like Janet Mills would just make promises without telling people her long-term plans to pay for it.”

Gov. LePage has opposed Medicaid expansion throughout his tenure, arguing that Maine’s previous generosity in the Medicaid – or MaineCare – program directly led to ballooning costs to taxpayers and massive debts to hospitals.

He has vetoed expansion bills seven times and continues to insist he will not implement it until lawmakers come up with a plan to fully fund it.

Last week, House conservatives sided with LePage to block a bill that would have tapped $60 million to provide startup funding for expansion. Roughly $35 million of that $60 million would have come from additional tobacco settlement funds negotiated by Mills, who was also the first to suggest earmarking the money for the expansion effort.

“The Legislature has spoken – they did not fund it,” LePage said. “And if they are not going to do it right, it’s just not going to happen.”

HIGH COURT TO HEAR LEPAGE APPEAL

Next week, Maine’s highest court will hear the LePage administration’s appeal of a Kennebec County Superior Court order that he submit a Medicaid expansion plan to the federal government. The lawsuit was filed by expansion advocates who are urging the estimated 70,000 eligible Mainers to still apply for Medicaid coverage despite the governor’s stance.

LePage’s statement that he would “go to jail before I put the state in red ink” was referring to that court case.

Asked about LePage’s jail comment, Mills said “it sounds like a very flip answer to a very, very serious problem.”

“When people are losing their lives in Maine due to lack of health coverage, it is not something that deserves a flip answer,” she said. “It is something that deserves a deep and thoughtful response, and that is what the people of Maine voted to do in expanding Medicaid.”

The costs of expansion have been hotly debated across the nation, including in many of the 33 states that have offered Medicaid coverage to additional adults.

Inslee said Washington has been able to pay for expansion without identifying a specific revenue source and has had an economic benefit by lowering emergency room visits, creating jobs and bolstering rural hospitals.

“I think it is a really safe assumption that you will save money in the state of Maine, as we have over time, in part by saving our rural hospitals,” Inslee said. “I’m sure that some of your smaller hospitals have the same challenges that we have, and we saved them because of this.”

REPUBLICANS POINT TO SHORTFALLS

But the Maine Republican Party pointed out that Inslee’s 2018 supplemental budget contained nearly $162 million to cover shortfalls in the state’s Medicaid program. While Inslee attributed that shortfall to inflation costs for pharmaceuticals, a December 2017 Seattle Times article cited a budget summary from his office in writing that “most of that money was needed because of ‘unrealistic’ savings assumptions made by state agencies and the Legislature.”

LePage recently has floated taxing Maine hospitals to pay for expansion, although the administration has yet to release a detailed bill or proposal.

For her part, Mills said funding Medicaid expansion would be decided as part of the Legislature’s budget-writing process. And she hit back at LePage for his anti-expansion stance as well as his failure, to date, to put his hospital tax proposal into legislation.

“He has drafted plenty of bills over the last six months and that is not one of them,” Mills said.

Meanwhile, some Mainers who may be eligible for MaineCare coverage under expansion have begun filing applications. It’s unclear how or when those applications will be reviewed, given LePage’s opposition and the uncertainties it creates.

Under federal regulations, if the state doesn’t complete its review of a Medicaid application within 45 days, the person is automatically deemed eligible for benefits. The governor has said that new Medicaid applications could create an overload for state staff, potentially delaying processing of applications for other benefits programs.

He said the state may simply deny applications that can’t be processed within the 45-day deadline in order to avoid automatic declarations of eligibility.

This report contains information from The Associated Press.

Kevin Miller can be contacted at 791-6312 or at:

kmiller@mainetoday.com

Twitter: KevinMillerPPH