It may seem like just another partisan standoff, but it’s much more than that — by failing to expand Medicaid, Gov. Paul LePage is breaking the law.

The governor is a politician, sure, but also an administrator, and in that role he is required to carry out Maine law, including the one passed by 59 percent of Maine voters last November.

He has paid lip service to doing so, even saying — to the amusement of everyone who has followed this issue closely — that he would “love” to expand Medicaid, if lawmakers would only give him the right tools. But in practice he has made that impossible.


After the law passed, LePage told lawmakers that he would only implement it if the Legislature passed funding that didn’t raise taxes, draw down the state’s rainy day fund or use any “one-time mechanisms or gimmicks,” ruling out many of the available sources.

In addition, he said the state would need nearly $100 million to carry out the law, about twice what the nonpartisan Office of Fiscal and Program Review said the first full year of expansion would cost, and that’s once everyone is enrolled. Nevermind that what is actually necessary for the remainder of this year is much, much less, and available in both the state surplus and its Medicaid account.

Still, in a show of compromise, and despite the governor’s ridiculous requests, lawmakers put forward a bill allocating $3.8 million to hire additional staff and cover administrative costs for the initial stages of expansion. It passed, but is now being held up in the dispute over the ending of the legislative session — House Republicans want to handle a series of bills one by one, which would allow LePage and the House GOP caucus to kill the Medicaid spending bill.

Those are the same House Republicans who stood in the way of multiple attempts to expand Medicaid through the legislative process, as they helped sustain the governor’s vetos. But now it’s not a popular bill the governor is blocking, but the law itself.


The law passed in November and put on the books earlier this year says clearly that the state must file a plan to expand Medicaid with U.S Centers for Medicare and Medicaid Services by April 3, a deadline LePage blew past without lifting a finger.

That has drawn a lawsuit from Maine Equal Justice Partners on behalf of other health advocacy groups and five Maine residents who would qualify for Medicaid once it is expanded. The filers are rightly concerned that the LePage administration won’t be ready to sign up people for the program beginning July 2, the next deadline in the law.

On that date an estimated 70,000 residents with income below 138 percent of poverty — or $16,753 annually for an individual — become eligible for Medicaid, or MaineCare as it is known here.

The federal government will cover at least 90 percent of the cost of most of the new enrollees. When fully operational, the program is expected to cost Maine about $55 million a year while bringing in more than $500 million in federal funds. The insurance will allow people to live fuller, healthier, more productive lives, while the funding will support thousands of jobs across the state.

Opponents have derided Medicaid expansion as “welfare” for “able-bodied” adults, but included in the expansion population are people like Gina Zamello and Charles McDaniel, two of the petitioners in the lawsuit.


According to the suit, Zamello, of Oakland, works part-time but makes below 138 percent of the poverty limit. She has a heart condition and neurological disorder, and while she sees a primary care physician whom she pay on a sliding scale, she cannot afford to see a specialist or get medications.

McDaniel, of Waterville, along with his wife earns about $1,200 a month, according to the suit. He would earn more, but a nerve problem limits his work, and he can’t afford treatment.

Elsewhere, Medicaid expansion has provided healthy outcomes and financial stability to people just like Zamello and McDaniel, and done it without significant increases in state spending. In fact, the economic advantages of expansion have been clear — according to the Kaiser Family Foundation, “National, multi-state, and single state studies show that states expanding Medicaid under the ACA have realized budget savings, revenue gains, and overall economic growth.”

But we only say that to show what Maine is missing. The efficacy of Medicaid expansion is not at issue today — that argument is over. It is the law, and the governor has to follow it.

Only subscribers are eligible to post comments. Please subscribe or to participate in the conversation. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.

filed under: