UPDATE, August 23, 4:16 p.m.: The Maine Supreme Judicial Court on Thursday dismissed Gov. Paul LePage’s appeal and ordered the Department of Health and Human Services to file a State Plan Amendment to secure federal funds for the voter-approved Medicaid expansion that LePage has refused to implement.
Advocates who fought for Medicaid expansion in Maine are not happy with Gov. Paul LePage’s (R) “empty excuses” for not implementing the voter-mandated law.
“This was not a friendly suggestion from voters saying this is something we’d like you to do. Voters in Maine passed the law—it is the law—and the governor has a responsibility to implement it and he’s done nothing to make that happen,” Robyn Merrill, executive director of the nonprofit Maine Equal Justice Partners (MEJP), told Rewire.News.
MEJP led the effort to put the expansion to a vote last year and filed a lawsuit on April 30 to compel the Department of Health and Human Services (DHHS) to implement the program expected to provide health insurance coverage to an estimated 80,000 Mainers.
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LePage has long opposed the Affordable Care Act and has threatened not to expand Medicaid despite the binding ballot initiative that passed in November.
The Maine Attorney General Janet Mills’ office declined to represent him to fight the lawsuit. A Democrat running for governor this fall, Mills recently announced how she would fund the Medicaid expansion in its first year using tobacco settlement money.
LePage’s administration filed its response to the lawsuit on Monday claiming it can’t do anything as the legislature has not appropriated money to fund this, that expansion would require the state to hire 100 extra workers, and that it is just too expensive.
“Now that Medicaid Expansion is the law, it is my responsibility to implement it, and I will. But until they [the legislature] adequately fund it, there is nothing we can do,” he said in a statement. “Before we can proceed with expansion, DHHS needs both the staff to implement it and the money to pay the bills that will come due when the state plan amendment is approved.”
Merrill said these are “empty excuses.” The funding is available, both in the state’s surplus funds and in the Medicaid account to cover implementation costs through May 2019. It is also “reasonable” for the legislature not to act until next year when the money is needed, she said.
“The lawsuit that’s before the court isn’t even about funding because this is focused on whether the governor submitted a state plan amendment to the state government, which doesn’t require any funding, but is required by the Medicaid Expansion Act and he didn’t do that. He’s getting all into these other arguments instead. That isn’t even what we are talking about,” Merrill said.
LePage’s comments are not made in good faith, Eliza Townsend, executive director of the Maine Women’s Lobby and the Maine Women’s Policy Center, told Rewire.News.
“The administration has not filed a state plan amendment, as required by statute. Further, the administration’s refusal to implement the law was one of the primary factors in the lack of resolution during the legislative session,” Townsend said. “The state has a budget surplus, so there’s adequate money to implement the law if all parties, including the administration, would simply agree to do so. Had the governor and his allies wished to implement the law, as his news release suggests, it could be under way by now.”
The state has projected surplus revenues of nearly $130 million in budget cycle ending in 2019 that could be used towards the Medicaid implementation, though House Minority Leader Ken Fredette (R-Newport) said last year that he expected GOP legislators to oppose using surplus funds to expand Medicaid. It would cost $55 million to pay for the first year of full implementation in 2021, according to the Bangor Daily News. Maine would be refunded 90 percent of the cost by the federal government, according to the nonpartisan Maine Office of Fiscal and Program Review.
A constitutional law expert in November told Rewire.News that LePage has no legal ground to halt Medicaid expansion.
LePage has vetoed Medicaid expansion under the Affordable Care Act (ACA) five times. Nearly 60 percent of Mainers voted for the expansion last fall. It is expected to provide health insurance coverage to an estimated 80,000 people who work but don’t have employer-sponsored health insurance or can’t afford a plan. They don’t qualify for Medicaid without the expansion. The state’s Medicaid enrollment would increase by 21.5 percent if the program were expanded, according to a new report on making Medicaid more accessible.
“The people of Maine supported the ballot measure by a substantial margin, in both urban and rural areas across the state. They have spoken. There is no excuse for the foot dragging that continues,” Townsend said.
Maine Equal Justice Partners filed the suit after the administration missed an April 3 deadline for an application to receive an additional $525 million in federal funding. The advocates argue the failure to expand Medicaid is harming people with low incomes. LePage contends the deadline doesn’t hold until money is appropriated. A judge has scheduled arguments on the lawsuit later this month.
A report released this week by the Kaiser Family Foundation debunked some of the most common arguments against expanding Medicaid through the ACA, or Obamacare—arguments LePage has made time and again as citizens and lawmakers push for Medicaid expansion.
“Medicaid expansion has not diverted coverage from traditional groups or significantly reduced state spending on other programs,” the Kaiser report said, addressing a frequently-cited GOP talking point that giving more people access to Medicaid services would come at the expense of others who receive government health-care services.
“Medicaid expansion is the law, and the law is clear that people should become eligible for coverage beginning on July 2, 2018.This has never been a question about money, but rather political will,” Amy Cookson, communications director for Planned Parenthood of Northern New England, told Rewire.News. “The state has money for expansion, particularly with a revenue surplus of $140 million and other funding options available. More than 70,000 Mainers are waiting to see a doctor, receive a life-changing diagnosis, or fill a prescription. They’ve waited too long, and their health and wellbeing shouldn’t be put at risk by this kind of politics.”
If LePage doesn’t act, his successor will have to follow through in January. A dozen candidates are vying for the governorship this fall, and Merrill said the health care expansion is a major issue of discussion.
“The legislature could have changed the law. The governor could have introduced legislation this year to repeal it. There were no efforts at all to change it or undo it and that’s because, I think, everyone knew that it wouldn’t succeed. The majority of the legislature supports the expansion because it’s clear the majority of the voters support it,” Merrill said. “It’s still the law, it’s still intact, and the governor has some obligations under the law regardless of what action the legislature has or hasn’t taken.”