A progressive advocacy group is expected to announce Thursday that it will gather petition signatures to potentially place Medicaid expansion on an upcoming statewide referendum ballot.

Five previous attempts to pass Medicaid expansion failed when Gov. Paul LePage, a staunch opponent of expansion, vetoed the bills, and the Legislature failed to override the vetoes.

If voters approved Medicaid expansion by referendum, it would sidestep LePage, as the governor cannot veto laws passed through referendum.

Maine Equal Justice Partners is expected to announce the effort at a news conference Thursday, several sources told the Press Herald, and officials with the Augusta-based advocacy group did not deny that Medicaid expansion was the topic of the news conference.

Ann Woloson, policy analyst for Maine Equal Justice Partners, said she couldn’t discuss the issue prior to Thursday.

“We are still hopeful that the Legislature will pass Medicaid expansion, but if they don’t there are tools available for the people of Maine,” Woloson said.

The earliest the question could appear on the ballot would be June 2017, but referendums typically appear in even years during statewide elections, when more voters are at the polls.

The legislative session begins in January. The latest attempt to pass Medicaid expansion this spring was spearheaded by moderate Republican senators Tom Saviello of Wilton and Roger Katz of Augusta, a compromise plan that would have required small premium payments for enrollees. Under traditional Medicaid expansion, those who qualify don’t pay premiums. The bill passed the House and Senate, but was tabled and died during the appropriations process.

“I applaud the efforts (by Maine Equal Justice Partners) and look forward to it. The people of Maine are in favor of this,” Saviello said.

Saviello said he would probably sign a petition to put the issue before voters, depending on the wording of the referendum.

Adrienne Bennett, a spokeswoman for LePage, said in an email response to questions that the effort was “another desperate attempt from liberals to pass welfare expansion for a sixth time.”

Sen. Eric Brakey, R-Auburn, the co-chair of the health and human services committee, said using the referendum to approve complex public policy like Medicaid expansion goes against the intent of referendums.

“I think the referendum process works when there are clear, black-and-white choices,” said Brakey, giving the examples of same-sex marriage and marijuana legalization. “It’s getting a little absurd. There’s a reason we have referendums, but there’s also a reason we have a Legislature.”

Brakey is opposed to Medicaid expansion, saying it would be a “huge policy mistake” because it would be expensive and take away from other priorities, such as government spending on nursing homes and education.

“That money has to come from somewhere,” Brakey said.

The federal government would pay for 95 percent of Medicaid expansion in 2017, followed by a reduction in the federal share to 90 percent by 2020. The federal government has promised to maintain the 90 percent reimbursement rate, but LePage has repeatedly cited his concern that the federal government will eventually cut its funding and leave state taxpayers on the hook to make up the difference.

That generous reimbursement rate would apply to about 60,000 of the 80,000 or so who would be newly eligible to sign up for Medicaid under expansion. But for about 20,000 Mainers eligible for Medicaid under expansion – parents who earn between 100 percent and 138 percent of the federal poverty level – Maine would be reimbursed at lower rates, with the federal government paying two-thirds of the costs and state taxpayers on the hook for the remaining third.

The Legislature’s nonpartisan Office of Fiscal and Program Review estimated the state would spend $93 million in state tax dollars on expansion through 2019, but receive nearly $1.2 billion in federal funds.

LePage’s spokeswoman disagreed with that assessment.

“We are talking about hundreds of millions of dollars over the next decade. It will bankrupt the state,” Bennett said.

Saviello countered that the benefits of Medicaid expansion outweigh the costs. For instance, when more people have health insurance, the health care industry needs to hire more people, who will be paying state taxes with their new jobs. Hospitals will have lower charity costs, which will put downward pressure on prices, Saviello said. Also, a healthier population should cost the system less money, he said.

“A colonoscopy costs a few thousand, but cancer can cost $50,000 or more,” Saviello said. “You can’t look at the cost of expansion in a silo.”

Jeffrey Austin, vice president of government affairs for the Maine Hospital Association, said the group doesn’t yet have a position on using the referendum process to pass Medicaid expansion, but that in general they support Medicaid expansion.

“We’re going to do whatever we can to pass expansion this upcoming (legislative) session and then, if necessary, discuss the referendum route after session,” Austin said.

 

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