Maine residents voted overwhelmingly to expand the state’s Medicaid program under the Affordable Care Act on Tuesday, approving a ballot measure on the issue by a whopping 18-point margin. But that doesn’t mean Gov. Paul LePage is ready to cooperate. The ogre-ish second term Republican announced in a statement Wednesday that he would not implement the law until the Legislature fully funded it.
“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget,” LePage said. “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.”
This was not a totally unexpected move, given that LePage opposed the referendum and has previously vetoed five different efforts by the state Legislature to expand Medicaid. The Maine Constitution says that governors do not have the power to veto ballot measures but can kick them back to the Legislature for an appropriation if they’d require funding. Since the federal government won’t pick up the entire cost of the expansion—after 2020 it’ll cover 90 percent of the expenses—Maine needs to decide how it will pay its share. Assuming the Legislature approves the funding, LePage should have 45 days to make a move.
Since I am not an expert on Maine’s politics or constitution, I called up Orlando Delogu, an emeritus professor at University of Maine School of Law, to ask whether the 80,000 or so people who could benefit from the Medicaid expansion should expect to receive health care any time soon. His answer, in short, was that Maine could be in for a political slog. On the one hand, Democrats and Republicans in the Legislature are used to dealing with LePage’s shenanigans and have the votes to fund that 10 percent of the expansion (early reports suggest there may be some arguments about exactly how to fund it). On the other hand, the governor often takes the position that, in Delogu’s words, “he doesn’t have to adhere to provisions of Maine law that he feels are inappropriate.”
But if legislators pony up the money, won’t LePage have to accept the referendum’s results?
“You’d think that to be the case, but he’s a wily man, and he’s dogged as a bulldog,” Delogu told me. “He may simply refuse to appropriate the money to the particular Affordable Care Act program. He may put the state in default to the federal government.”
Those sorts of delay tactics may not turn out to be legal, but the point is, LePage will push the limits.
“He will not go quietly into becoming the 32nd state to participate in the Medicaid expansion,” Delogu said.