Health care advocates around the State House are discouraged — and, since 2014, they’ve been awfully quiet. There has been no greater mistake during his six years in office than Gov. Paul LePage’s refusal to accept federal Medicaid funding for up to 100,000 people, yet he doesn’t even feel compelled to talk about it.

The current version of Medicaid expansion, L.D. 633, is still technically alive for Friday’s “veto day,” when lawmakers will consider a ridiculously large number of LePage’s rejections, but stands no realistic chance of success. It’s a Republican bill, sponsored by Sen. Tom Saviello, which would use private insurance, modeled on New Hampshire’s program, to provide coverage.

The bill, after squeaking through the Senate by one vote — freshman Sen. David Woodsome provided a new Republican vote for it, along with a Medicaid stalwart, Roger Katz — was recommitted to the Appropriations Committee by Katz so it could be retooled to narrowly focus on drug addiction treatment.

It was thought the opioid overdose issue would provide a new avenue for pursuing Medicaid coverage — without it, there’s scant chance many of those addicted can get treatment — but it’s been another cul de sac. Separating addiction treatment from funding for cancer and diabetes would be a dubious policy move, and even more likely to earn a veto from LePage, who again opposes the life-saving anti-overdose drug Narcan because, apparently, addicts deserve to die.

It’s puzzling. Legislative Democrats have abandoned the issue; since sending five bills for LePage to veto in 2013-14, House Speaker Mark Eves no longer mentions the subject, and press conferences for L.D. 633 didn’t include Democrats. Even more conspicuous by their absence at public events have been those who could be the most effective advocates for Medicaid: Maine’s hospitals.

I spoke to one hospital executive who said there was little more hospitals could have done, but I don’t believe it. A letter from every hospital in rural Maine to the governor, pointing out the financial stress and job cuts his Medicaid decisions have caused them, with copies to reporters, might not change his mind, but would focus attention on an impending crisis.

The Affordable Care Act contains reductions in Medicare reimbursements for seniors, balanced by the new Medicaid funding LePage has denied. Without this funding, one hospital has gone bankrupt, several needed rescue by larger hospitals, and more will follow.

The hospitals’ near-silence has allowed the former hospital association lobbyist, Mary Mayhew, to make ridiculous claims about the cost of Medicaid expansion, now as LePage’s health and human services commissioner.

As soon as L.D. 633 was cleared for floor action, Mayhew issued a broadside claiming it would cost $315 million “over five years.” The Maine Heritage Policy Center upped that to $500 million, claiming private insurance would cost more. Neither number has any factual basis.

Here are the facts, from the bill’s fiscal note: During the first two full years of expansion, the state would pay $80 million while bringing in $938 million in federal funding. And even that cost could be eliminated.

The Pew Foundation convincingly argues that states like Maine, which expanded Medicaid earlier, will get higher payments for many now covered through “traditional” Medicaid. Alternatively, advocates could back a U.S. Senate bill introduced by Angus King, taking up a budget proposal from President Barack Obama, to provide late-expanding states like Maine with 100 percent payment for three years.

Given the lack of a concerted Medicaid campaign, this may all seem academic, but it’s not. One way or another, we need a strategy to overcome LePage’s obstinance, and ensure that 2016 is the last year we deny coverage to thousands of Mainers who could get it with one stroke of a pen.

There are two possibilities. One is electing a Legislature that would vote overwhelmingly in favor. Given Donald Trump’s likely position atop the Republican ticket, it could happen.

The other is a referendum putting the issue to a statewide vote. Advocates have avoided that course, while measures to boost the minimum wage and increase income taxes on the wealthy to support schools went ahead. They were concerned a referendum would attract a blizzard of national anti-Obamacare spending, the same forces that prompted 50 repeal motions in Congress against this moderate, sensible and overdue law.

Depending on November’s results, either strategy could be viable. What’s not acceptable is simply waiting for Paul LePage to leave office. This time, let’s get all hands on board. It’s a test of whether common sense and good policy can overcome the forces of unreason and darkness.

Douglas Rooks has covered the State House for 31 years. Comment is welcomed at: [email protected]

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