A judge told us last week what common sense should have told everyone a long time ago:

Paul LePage doesn’t have to like Medicaid expansion as a matter of policy, but he does have to implement the program because it’s the law. And even the governor has to follow the law.

The logic is clear, but LePage has indicated that he will appeal Murphy’s decision, which will likely push any positive action beyond his term in office, which ends officially on Jan. 2.

If that’s a victory for LePage, it’s a short lived one. Gov.-elect Janet Mills has pledged that she would implement Medicaid expansion on “Day 1,” making an addition 80,000 people eligible for the MaineCare program, using mostly federal funds.

For five years, one man has kept Maine out of this program. What did he achieve?

For starters, he refused an estimated $2 billion that would have been paid out to hospitals, doctors, nurses, support staff and others who make their livings providing health care. Between $350 million and $500 million in federal funds would have been circulating in the Maine economy, especially in places where the local hospital is the biggest employer.

He also refused to participate in the financing mechanism that other states used to fight the opioid epidemic;. As the death toll mounted, thousands of Mainers waited for access to treatment programs because so many of the people hit by substance use disorder were not covered by insurance.

And he let people suffer needlessly because their own health or a disabled family member’s prevented them from working full time in a job that provides benefits.

LePage has been against the program since the Supreme Court gave states the option of refusing to expand eligibility under the terms of the Affordable Care Act. LePage’s opposition has been consistent, but his reasons have changed over time.

In 2013, when the first three years of expansion were 100 percent funded by the federal government, with the next seven years limited to no less than 90 percent federal funds, LePage said that wasn’t good enough. His commissioner of Health and Human Services, Mary Mayhew, requested that Maine receive federal funding for the entire 10 years, and was turned down. When the Legislature passed a bill to accept the government’s terms, LePage vetoed it, and held on to enough support from House Republicans to prevent an override.

Different versions of the bill were drafted to meeting LePage’s shifting objections. Republican Sen. Roger Katz proposed a bill that would accept federal funding only for the 100 percent reimbursement period and would have the program expire, requiring a new law to be passed before the state spent any money.

LePage vetoed it and was upheld. Republican Sen. Tom Saviello tried a version in which people at the higher end of the eligibility scale could buy Medicaid coverage. LePage vetoed it again. By now his objection was with the unworthiness of the people who would access coverage, who LePage described without evidence as people who refuse to work.

Finally, after five vetoes, a citizen initiative went before the voters last year and passed with nearly 60 percent of the vote. That’s a law that can’t be vetoed, and the constitution requires the governor to implement it, whether he likes it or not.

By now the governor’s objection was that he didn’t like the way the state’s share would be financed. He vetoed a bill that would spend $60 million out of the state’s existing Medicaid fund.

But the governor can’t veto his way out of this one.

LePage can delay expansion, but he can’t delay it much longer. This mean-spirited policy will leave the state for good with the governor himself if he keeps his promise and abandons Maine for Florida next year.


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