The most shocking part of Gov. Paul LePage’s recent comments about the Affordable Care Act isn’t actually the part where he called the Internal Revenue Service the “new Gestapo.”

Yes, that’s an absolutely unacceptable insult to the victims of Nazi Germany and completely indefensible in an official statement. It gives credence to the most extreme and hateful bigotry about the issue and brings ridicule on our state.

Another part of his remarks, however, may have more of a negative impact for Mainers: the part where he said that as governor, he will refuse to implement important parts of the new federal law.

The provisions of the law that LePage is denying are the setting up of a Maine health care exchange and the expanding of Medicaid coverage to more people without health care.

The exchange is simply a structure and a website to allow people to compare insurance plans, where no one can be denied coverage because of a pre-existing condition, and through which individuals will receive a federal subsidy to make sure they can afford coverage.

The Medicaid expansion would cover more of the young, the old and the poor, and would be completely paid for by the federal government for the first three years. From 2020 onward, states would have to pay only a maximum of 90 percent of the cost of coverage.

Refusing to implement these common-sense, helpful parts of the federal law is bad enough, but it appears that LePage actually wants to go one step further.

As the Wall Street Journal revealed a few days ago, “Within hours of the Supreme Court’s ruling on June 28, lawyers in the Maine attorney general’s office began preparing a legal argument to allow health officials to strike more than 20,000 Medicaid recipients from the state’s rolls.”

Rather than just refusing to implement new programs, LePage is seeking to use the court’s decision to drop care for people targeted in his budget who currently receive help through MaineCare, without seeking a waiver from the federal government.

In his remarks, LePage acknowledged that he will be attacked for “turning down free health care,” but claims that since the money has to come from somewhere, he’s actually being fiscally smart.

This ignores the fact that the health care or the cost of the lack of health care for the people he’s cutting has to come from somewhere, as well.

When people can’t afford coverage and become seriously ill, they still get treatment at a hospital, only it’s through emergency charity care and it costs us all much more in the long run through our taxes and insurance premiums.

Even if we ignore the federal subsidy, the fiscal benefits of a healthy population and work force and our moral duty to help those who need it, denying coverage to these people makes no economic sense.

Basically, LePage is choosing not to cover people not because of the state’s fiscal situation but because of his own personal, political disagreement with President Barack Obama and the Affordable Care Act.

This fits with the governor’s larger strategy. Since coming into office, LePage and his Republican allies have had two simple objectives about health care: Cut coverage for people on MaineCare and remove the oversight of and increase the profits of insurance companies.

We saw this in the budgets, where they found hundreds of millions of dollars to give new tax breaks that mostly benefit the wealthy and at the same time cut care for people who need it.

We saw this when they passed Public Law 90, which allowed insurance companies to drastically increase premiums, especially on rural small businesses and the elderly.

Some business owners already have seen their rates nearly double.

Despite their proclaimed disapproval of taxes, Republicans even passed a special tax as part of that law that will subsidize the insurance companies to the tune of $22 million.

Now we see it again, in clearer language than ever before. LePage obviously has a fundamental, philosophical disagreement with the government helping people afford health care, and he’s willing to do and say some extreme things stop that from happening.

Demographically, Maine is the oldest state in the country. We also have one of the highest rates of small-business owners and small-business employment. These are groups that are particularly affected by the issue of health care and that, for the most part, don’t share LePage’s philosophy.

These are also groups that vote in disproportionately high numbers, something that LePage and Republicans may soon realize.


Mike Tipping is a political junkie. He writes the Tipping Point blog on Maine politics at, his own blog at and works for the Maine People’s Alliance and the Maine People’s Resource Center. He’s @miketipping on Twitter. Email to [email protected]

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