That Maine Medicaid expansion isn't happening just yet

Yesterday morning we learned that the voters of Maine had overwhelmingly supported a referendum aimed at expanding Medicaid to another 70,000 residents under the provisions of Obamacare. At the time, I pointed out some of the pitfalls awaiting them down the road, but it seemed there was little to be done at this point. But it turns out that Governor Paul LePage (who vetoed five previous attempts at this) still had one more card to play. He’s not going to buck the will of the voters entirely, but he’s also dumping the problem into the lap of the legislature, telling them to figure out how to pay for all of this “free healthcare” without bankrupting the state. (Maine Government website, emphasis added)

“The last time Maine experimented with Medicaid expansion in 2002 under then-governor Angus King, it created a $750 million debt to hospitals, resulted in massive budget shortfalls every year, did not reduce emergency room use, did not reduce the number of uninsured Mainers and took resources away from our most vulnerable residents—the elderly and the intellectually and physically disabled,” said Governor LePage.

“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget. Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated, and I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.”

There are two faces to this particular coin… the practical and the political. On the practical side, it seems likely that the legislature will be able to come up with some sort of a package to put on the Governor’s desk. It may take some time and be weak in terms of unfunded liabilities, but given the lopsided result of the referendum vote, it’s almost certainly going to happen some time next year.

But on the political side, this is a cagey move by LePage. He’s already made his case against this sort of financial albatross in the past, but now that the reality of the expansion is on the horizon he’s set forth a group of milestones which he and his supporters will be able to point to in the future. If the legislators want to jack up taxes, dip into the state’s budget surplus or reduce services, there will be angst among the voters and LePage has put a firewall between himself and any electoral blowback.

Assuming the legislature comes up with some other, more “creative” package to make this happen and the state’s budget tanks the way it did under Angus King, the blame will fall directly on the Democrats. (King is technically an independent, but as we saw when he went to the Senate he immediately announced he would caucus with the Dems.)

In this way, the people wind up getting what they asked for, but LePage and the Republicans in Maine can basically sit back, break out the popcorn and watch what happens. It’s democracy in action, which is fitting since this passion play is somewhat reminiscent of a famous quote from H.L. Mencken. “Democracy is the theory that the common people know what they want, and deserve to get it good and hard.”