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Universal At-Home Care Measure Dies

In Maine, which has a greater share of older residents than any other state, voters rejected a ballot measure that would have provided free long-term care to anyone who needs it.

Home health care aide helping an elderly woman walk.
(TNS/Jay Reiter)


  • Voters in Maine, the oldest state by age, rejected what would have been the nation's first universal home health-care program.
  • It would have been funded through a 3.8 percent tax increase for wealthy residents.
  • All four candidates running for governor opposed the ballot measure.
Maine voters have a tendency to make U.S. history on election days. In 2016, they made their state the first to approve ranked-choice voting. In 2017, they became the first to pass Medicaid expansion at the ballot box. This year, however, they rejected what would have been the nation's first universal home health-care program. 

The measure, Question 1, would have created a state-run program that provided free at-home services for anyone in need of long-term care, largely the elderly and disabled. To pay for it, the proposal would have enacted an extra 3.8 percent income tax on residents making more than $128,400 a year. 

The measure attracted a lot of money to the small state, with supporters raising almost $2 million and opponents raising $1 million. 

Supporters said the proposal was a response to what they call a long-term care crisis. Maine is the oldest state in the U.S. by age, and a report by Maine’s Department of Labor estimates that the state will need more than 1,900 nursing and residential care employees by 2024 to meet demand. 

"We’re cutting Meals on Wheels at this point," said Mike Tipping, spokesperson for Maine’s People Alliance, an advocacy group that supported the referendum. Legislators this year declined a $500,000 expansion of the state’s Meals on Wheels program. "It’s important to just take a big step forward."

Most of the money collected from the tax -- 77 percent -- would have gone toward workforce development, training and pay raises for home care staffers.

"Home care is one of the fastest-growing jobs, but home care workers now make minimum wage. We’re seeing a 67 percent turnover rate," said Tipping.

All four gubernatorial candidates opposed the measure, including Democrat Janet Mills, who won on Tuesday. Mills told the Bangor Daily News that it's important "to do what is right for Maine and make the tough calls -- not to do merely what is politically correct or expedient."

Republican nominee Shawn Moody said he believed seniors and the disabled need more long-term care but disagrees with achieving that this way.

"We cannot continue to punish people with higher taxes," he told the Bangor Daily News.

Opponents like Moody also argued that the tax would be an economic drain on the state.

"Our primary concern is it would give Maine the highest income tax rate in the country, and Maine is not a wealthy state," said Jeffrey Austin, vice president of policy and government affairs for the Maine Hospital Association, which opposed the measure. "It would fall to our members to do recruitment of health professionals, and that’d be hard. We only have one border state, New Hampshire, which has no income tax. If you’re coming out of a residency program and thinking about northern New England, why would you come to Maine with income taxes that high, when you could have none?"

For results of the most important ballot measures, click here.

Mattie covers all things health for Governing.

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