Maine Votes On Expanding Access To Medicaid : Shots

Kathleen Phelps, who lacks medical insurance, speaks in favor of increasing Medicaid at a information convention in Portland, Maine on Oct. 13, 2016.

Patty Wight/Maine Public Radio

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Patty Wight/Maine Public Radio

Kathleen Phelps, who lacks medical insurance, speaks in favor of increasing Medicaid at a information convention in Portland, Maine on Oct. 13, 2016.

Patty Wight/Maine Public Radio

Maine is one in all 19 states that rejected Medicaid growth by the Affordable Care Act. But on Tuesday, it might be the primary to approve it on the poll field.

Question 2 asks Maine voters in the event that they wish to present roughly 70,000 Mainers with well being care protection by increasing eligibility of Medicaid, referred to as MaineCare. It gives well being protection for folks dwelling at or close to the poverty line.

The nationwide battle over Medicaid growth started with a 2012 U.S. Supreme Court choice that conservatives initially hoped would hobble the Affordable Care Act, President Obama’s signature legislative achievement.

But as a substitute of repealing the legislation’s particular person mandate requiring that almost all Americans receive medical insurance, the court docket upheld it. The court docket then struck down a provision requiring all states to increase eligibility of Medicaid.

That shock 2012 court docket ruling shifted the political battle. While the GOP-led House of Representatives would go on to take over 50 symbolic ACA repeal votes, progressive and conservative activists descended on state legislatures to struggle over Medicaid growth.

The depth of these battles illustrated the significance of Medicaid growth as a element of the ACA. The program not solely lowered the variety of folks with out medical insurance it, additionally has arguably made repealing the well being care legislation tougher.

Medicaid funding cuts included in Senate payments to repeal ACA have been the first purpose that Sen. Susan Collins, R-Maine, broke ranks with a lot of the GOP to oppose the payments.

“First, both proposals make sweeping changes and cuts in the Medicaid program. Expert projections show that more than $1 trillion would be taken out of the Medicaid program between the years 2020 and 2036,” she mentioned in September. “This would have a devastating impact to a program that has been on the books for 50 years and provides health care to our most vulnerable citizens, including disabled children and low-income seniors.”

Collins has additionally cited the impression on Maine’s rural hospitals, that are closely depending on Medicaid reimbursement funds.

Effects On The Uninsured

Architects of the federal well being care legislation sought to decrease the variety of folks with out medical insurance by requiring most Americans to have protection. The legislation additionally lets states increase entry to Medicaid, a federal program run by the states and funded with a mixture of state and federal cash.

In 2013, Maine’s legislature voted to increase the state’s program, and Republican Gov. Paul LePage vetoed the invoice. It was the primary of a half dozen vetoes.

About 9 p.c of Maine residents lacked insurance coverage in 2016, comparable to eight.6 p.c within the 31 states and the District of Columbia that expanded Medicaid. That might be as a result of the state had expanded its program in 2002 and 2003.

The variety of folks enrolled in Medicaid has been dropping, because the LePage administration moved aggressively to limit eligibility

In 2012, there have been 345,000 Mainers receiving Medicaid. There have been 268,000 by June of this yr, in accordance the Department of Health and Human Services. The state spends $2.6 billion on this system, with two-thirds of that coming from the feds.

Meanwhile, roughly 70,000 Mainers have fallen into what’s referred to as the ACA protection hole. The hole happens within the 19 states that didn’t increase Medicaid.

The ACA initially conceived Medicaid growth as a bridge between low-income adults already eligible for Medicaid protection and those that may qualify for subsidies to buy their very own particular person plans.

But with out growth, 1000’s of Mainers neither qualify for subsidies nor Medicaid.

Most of the 70,000 individuals who would achieve protection if Question 2 pbades earn as much as 138 p.c of the federal poverty stage — about $16,000 a yr for a person and $34,000 for a household of 4.

For And Against

Conservative and progressive activists have engaged in a protracted, pitched struggle over Medicaid growth. The arguments for and in opposition to growth have not modified a lot, and neither have the strategies of persuasion.

Conservatives repeatedly observe that Maine was an early expander of Medicaid in 2002-2003. They declare that the state’s uninsured price was unaffected by growing eligibility and that this system grew to become a finances buster, creating deficits when state revenues declined in the course of the financial downturn.

Progressives counter that early growth helped preserve Maine’s uninsured price regular whereas different states noticed a surge. Additionally, they argue that the upper federal reimbursement price provided by the ACA protects the state.

If growth pbades, the federal authorities will initially cowl 94 p.c of the price. That ratchets all the way down to 90 p.c by 2020 and stays at that stage, so long as Congress would not minimize reimbursements.

But Brent Littlefield with the anti-expansion Welfare to Work PAC says there’s nonetheless a price to Maine taxpayers.

“The current plan would have state taxpayers paying between $50 million to $100 million per year,” he says.

The growth debate has been marked by its heated rhetoric. Opponents have repeatedly referred to as would-be recipients “able bodied,” whereas calling the proposal “welfare expansion” — descriptions designed to faucet sharply divided public perceptions of individuals receiving public help.

Proponents, in the meantime, have been stressing the human impression, specializing in private tales of those that would profit from this system.

High Stakes

Welfare ToWork

Question 2 has been billed by some as a closing decision, nevertheless it may be a litmus take a look at for public sentiment concerning the Affordable Care Act. GOP repeal efforts haven’t polled properly. While the ACA has not been a centerpiece of the proponents’ arguments for growth, an affirmative growth vote on Nov. 7 might be spun as a tacit public endorsement for the well being care legislation, as a result of Medicaid is such a key element.

Locally, the political stakes are excessive. LePage has been a number one critic of growth, and he is taking an energetic position in opposing Question 2. Defeating Question 2 may validate the governor’s stance. Conversely, an affirmative vote may deal a blow to the governor’s full-court press in opposition to the legislation.

But a victory for supporters of Question 2 might be fleeting. The state legislature modified, delayed or tried to repeal all 4 of the poll initiatives that voters authorized final yr.

Steve Mistler is chief political correspondent for Maine Public Radio.

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