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Maine's Medicaid Vote a Test of Obamacare Support

If passed, the state would become the 33rd to expand Medicaid and signal support for Obamacare at a time when President Trump is taking major steps to reverse it.

Maine Legislature
A rally in support of health care in Maine.
(AP/Robert F. Bukaty)
This story is part of our elections coverage. Read our list of the most important races and ballot measures to watch here.

The Maine Legislature has voted to expand Medicaid five times in the last five years. But every time the bill reached GOP Gov. Paul LePage's desk, he vetoed it.

So advocates of expanding Medicaid decided to go straight to voters. They collected enough signatures to put the issue to voters in November.

If passed, the state would become the 33rd to expand Medicaid and signal support for former President Obama's signature health-care law at a time when President Trump is taking major steps to reverse it.

In the last few weeks, Trump weakened the Affordable Care Act's birth control mandate, signed a wide-ranging executive order that, among other things, allows for more unregulated plans, and announced the end of subsidies that help low-income consumers buy insurance.

Under Obama's Affordable Care Act (ACA), the federal government pays 100 percent of the costs of increasing Medicaid eligibility to people who make incomes up to 138 percent of the federal poverty line, which is $32,000 for a family of four. Gradually, the feds' bill drops to 90 percent.

Republicans in Congress have spent this year trying to repeal and replace the ACA, and most of their attempts eliminated funding for Medicaid expansion, which proved to be a dealbreaker for Democrats and many Republicans. In fact, two Maine congressmembers -- Republican Sen. Susan Collins and Independent Sen. Angus King -- were instrumental in defeating those bills. 

“In many ways, the debate about health care starts and ends in Maine,” says David Farmer, spokesperson for Mainers for Health Care, which supports expanding Medicaid.

Opponents of the Maine measure argue that expanding Medicaid there is different than any other state. In 2003, former Gov. John Baldacci expanded Medicaid coverage and subsidized private insurance. Medicaid costs ballooned, and eventually the state fell behind on Medicaid reimbursements for hospitals. When Gov. Paul LePage took office in 2011, he began dismantling the eligibility requirements down to only children, pregnant women and adults with dependents. 

“We already did this, we already tried this experiment. It can’t come back,” says Brent Littlefield, spokesperson for Welfare to Work PAC, a coalition against the ballot measure. 

Supporters of the measure say that with the federal government still picking up most of the tab for Medicaid expansion, there’s no reason not to try. Farmer cites the fact that the legislature has already passed it several times, and that the major health-care associations in the state have endorsed the measure. 

“It’s hard not to feel that momentum,” he says.

The measure has been a big point of contention in the state in recent months. Gov. LePage wanted the word ‘welfare’ to appear somewhere on the ballot but was shot down. The Republican party in the state, however, was able to change the phrase “health insurance” to “health coverage" in an attempt to clarify that Medicaid is government-funded health benefits.

The supporters have outraised the opponents four to one. Supporting committees have almost $800,000 on hand, while opposing committees raised close to $200,000. Littlefield argues, however, that supporters have relied heavily on out-of-state donations. 

There hasn’t been any formal polling on the initiative, and neither spokesperson wanted to speculate where public opinion stands. Farmer, however, says that “residents are more engaged and better informed on the topic than ever before.”

This story is part of our elections coverage. Read our list of the most important races and ballot measures to watch here.

Mattie covers all things health for Governing.

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