If you look hard enough, you’ll see that Medicaid expansion is on the ballot again this year.

There won’t be a referendum – that was decided in 2017, when a plan to use mostly federal funds to extend health coverage to an estimated 70,000 low-income Mainers won by a landslide. But those people are still waiting as we head into this year’s gubernatorial race, where there is a sharp divide between the contenders on this issue.

Democratic nominee Janet Mills favors accepting the deal, which would extend Medicaid coverage to people with incomes of up to 138 percent of the federal poverty threshold, or just under $17,000 a year for an individual and $35,000 a year for a family of three. Both independents in the race, Alan Caron and Terry Hayes, also want Maine to get on board.

But Republican Shawn Moody’s spokeswoman said the candidate would not implement the law unless the Legislature funds the state’s share under the same set of conditions laid out by Gov. Paul LePage earlier this year. Those conditions rule out “raising taxes, draining the rainy day fund or using other budget gimmicks.”

Quoting the governor on Medicaid speaks volumes. LePage’s picky attitude about the revenue source for the state’s share is the most convenient weapon he has in his war to keep Maine out of the program.

He had been a fierce opponent of expanded Medicaid eligibility since coming to office in 2011. Starting in 2013, majorities in the Legislature voted five times to pass bills that would have accepted the federal funds, and each time, LePage vetoed it. Last year, citizens went over his head and passed the Medicaid expansion law by referendum.

Since he couldn’t veto a referendum, he introduced his own rules for the type of funding he would consider acceptable for the state’s share, and refused to do even the routine paperwork required by the law. A bipartisan bill to fund the program was passed by the Legislature, and the governor vetoed it, while claiming his hands were tied by the lack of funding. LePage defied deadlines until he was ordered to move forward by a Superior Court justice, a decision that was upheld by the Maine Supreme Judicial Court. Out of options, Maine is submitting a plan to the Department of Health and Human Services, but LePage sent a separate letter encouraging officials on the federal level to reject it.

While we don’t know what the federal government will do, we can safely predict that the governor is not done trying prevent people from signing up for health coverage through expanded Medicaid. This issue is not likely to be resolved before he leaves office, so it really matters where the candidates to replace him stand.

Once it’s fully implemented, expanded Medicaid is projected to cost roughly $50 million a year in state funds, drawing more than $500 million from Washington, a match of better than 9-to-1. Some of that money would go to out-of-state drug companies and device manufactures, but the bulk would be spent in Maine communities supporting health care jobs.

Thirty-two other states and the District of Columbia have already entered the program and found it to be an economic winner. Some states were surprised that more people than anticipated signed up for coverage in the first year, but the surge leveled off. So far, not a single state that opted into the program has decided to drop out of it and forgo the federal funds.

A detailed study of Ohio’s program found that while the uninsured rate plummeted, participants reported being in better health and were able to find and hold jobs more successfully than before Medicaid eligibility was expanded.

Maine should have expanded Medicaid in 2013 when the program went into effect (and when the federal government paid 100 percent of the cost). The issue should have been taken care of shortly after the voters spoke so forcefully last year.

But with only two months until this year’s election, Maine’s status regarding Medicaid expansion is still unresolved. That’s why, if you look hard enough, it’s on the ballot again.

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