Medicaid Expansion's Fate Up to Courts as Maine Lawmakers Sustain Governor's Veto

The Maine House sustained Republican Gov. Paul LePage's veto of a funding bill for Medicaid expansion Monday, handing him another victory in his long campaign to stifle expansion of the program to another 70,000 Mainers.

By Scott Thistle

The Maine House sustained Republican Gov. Paul LePage's veto of a funding bill for Medicaid expansion Monday, handing him another victory in his long campaign to stifle expansion of the program to another 70,000 Mainers.

However, the state Supreme Judicial Court could alter the expansion picture next week, when it hears arguments in a challenge brought by advocates who want to force the governor to file an expansion plan with the federal government.

Conservative Republicans stood with the governor in Monday's 85-58 vote, which fell short of the two-thirds majority needed to overturn his veto of $60 million to help fund a law that 59 percent of voters approved at referendum in 2017.

The veto marks the seventh time during his two terms in the Blaine House that LePage, with the backing of minority House Republicans -- many of them first elected with him in 2010 -- has been able to thwart legislative efforts to expand the state and federally funded health insurance program for the poor.

The bill provided state funding that would be matched by more than $500 million in federal funds to expand Medicaid to between 70,000 and 80,000 more Mainers. Supporters say costs to the state would be less than $50 million once the expansion is fully implemented, but opponents contend the cost could be twice that. LePage and his allies have demanded a "sustainable" funding mechanism for the expansion.

The governor's obligation to move forward with expansion is the focus of the hearing before the state's Supreme Judicial Court next week. Justices will take up a suit that pits advocates for expansion against the administration, which has argued that it cannot implement the law without funding approved by the Legislature.

LePage said in his veto message to the Legislature that the state needed to come up with a sustainable way to fund the expansion and not depend on one-time gimmicks. The bill he vetoed would have funded expansion with surplus revenue as well as money from the state's tobacco settlement fund. In his message, LePage also criticized those who backed the ballot measure for not writing a funding method into the citizen-backed law.

House Speaker Sara Gideon, D-Freeport, who supported the funding bill, said LePage's successful veto does not change the fact that expanding Medicaid is required by law as a result of last fall's referendum vote, and that it was still up to LePage and the Legislature to pay for it.

"This latest action is yet another tactic to not just delay, but to obstruct the law that Mainers passed overwhelmingly at the ballot box," Gideon said in a prepared statement. "Regardless of the outcome of this veto, Medicaid expansion is the law of the land. The only item for discussion is whether we fund it now or fund it later."

Mainers who make up to 138 percent of the federal poverty limit were eligible to submit applications for coverage as of July 2, but it's unclear how quickly the state will make benefits decisions with LePage still in office until January of 2019. Earlier this month Maine Equal Justice Partners, a non-profit group that advocates for the poor in Maine and primary backer of the ballot-box law, was urging those who believe they may be eligible to be begin applying for coverage.

The organization's staff and other advocates said once the funding for expansion is finally settled, those newly eligible for coverage would be receive benefits retroactively.

But whether the state's high court will force LePage to file a plan for expansion with the federal Centers for Medicare and Medicaid, as prescribed for under the Affordable Care Act, remains uncertain.

Kathy Kilrain del Rio, a policy analyst for MEJP and a member of Mainers for Health Care, the coalition that backed the ballot measure, asserted that Monday's vote means Maine will miss out on available federal funding.

"Those funds will sit on the table while the people who have a legal right to care turn to the courts to force the administration to implement the law," Kilrain del Rio said. "A bipartisan group of legislators stood against this senseless obstruction and delay, but a minority of lawmakers blocked the will of the voters once again."

The Maine Democratic Party was quick to weigh in Monday, noting their party's nominee to replace LePage, Attorney General Janet Mills, has said she would support an expansion of the program and find ways to cover the state's share of the expense.

"Janet Mills knows expanding Medicaid will make Mainers healthier and be a substantial boost for our economy," Maine Democratic Party Chairman Phil Bartlett said. He noted that the Republican candidate for governor, Gorham businessman Shawn Moody, has vowed to work to repeal the expansion law if elected.

Lauren LePage, LePage's daughter and Moody's campaign spokeswoman, said in an email that Moody would "enforce the laws on the books with appropriate funding from the Legislature who under the Constitution must pass all spending bills." She did not say if Moody has any ideas on how he would pay for expansion.

Mills said expansion would inject millions of dollars into the state's economy, help create jobs, support rural hospitals and assist in the state's ongoing struggle against an opioid overdose epidemic that claims, on average, one Maine life a day.

"As governor, I will work to see that Medicaid expansion is fully implemented so that people across the state can access the care they need and deserve, and I will fight back against any attempt to undermine it or repeal it," Mills said in a prepared statement. "Maine people deserve more health care, not less."

Alan Caron, an independent running for governor, called LePage's veto the latest in "a long string of mistakes on health care," and pointed out that the federal government funds 90 percent of costs.

State Treasurer Terry Hayes, also an independent running for governor, said she understands some of LePage's concerns about funding sources but also criticized him for refusing to work with lawmakers.

"If there were collaboration between the executive branch and the legislative branch, then there is a greater likelihood that the governor's preferences could have been included in the bill or there would have been a dialogue," she said.

Hayes said she would look to use tobacco settlement funds and revenue from the state's wholesale and retail liquor contract to fund expansion costs long-term.

(c)2018 the Portland Press Herald (Portland, Maine)

Caroline Cournoyer is GOVERNING's senior web editor.