Maine Governor Continues to Fight Medicaid Expansion, Despite Court Setback

Published October 19, 2018

On September 5, the LePage administration complied with a court order requiring the governor to submit documents to expand Medicaid to as many as 90,000 additional Mainers. LePage is asking federal officials to deny the application.

“I strongly encourage [the U.S. Centers for Medicare and Medicaid Services] to reject the State Plan Amendment that may soon be submitted by the Maine Department of Health and Human Services pursuant to court order,” LePage wrote in a letter to CMS Administrator Seema Verma and U.S. Health and Human Services Secretary Alex Azar. “If accepted, the SPA would commit Maine to expanding the Medicaid program to an additional 70,000 to 90,000 individuals. However, not one dime of the hundreds of millions of dollars that will be needed to pay for the state’s share of the expansion has been appropriated.”

Says Medicaid Is Unsustainable

States should reform Medicaid before considering an expansion of the pro- gram, Idaho Freedom Foundation Vice President Fred Birnbaum says.

“Gov. LePage understands that the current trajectory of Medicaid is not sustainable and that it is irresponsible to simply expand Medicaid without reforming it first,” Birnbaum said. “For example, in Idaho, the traditional Medicaid caseload has increased 70 percent from fiscal year 2007 to fiscal year 2019, but the population has only increased 17 percent. That matters because proponents of Medicaid expansion are very fiscally irresponsible to claim that the federal match rate funding of 90 per- cent is either ‘free money’ or is a return of tax dollars. It is neither. It is incremental, borrowed money that will be added to the federal debt.”

Sicker Patients Suffer

Charlie Katebi, a state government relations manager at The Heartland Institute, which publishes Health Care News, says the 33 states that have expanded Medicaid to able-bodied adults have been burdened with rising costs and reduced health care access for all patients.

“LePage is up against leaders of an expansion campaign that are selling the idea that Medicaid expansion means better health care access to the indigent and needy,” Katebi said. “But the truth is that expanding coverage to able-bodied adults harms Medicaid’s traditional enrollees, especially those with developmental disabilities or serious injuries affecting their brains or spines. The myth of Medicaid expansion is that the federal government will cover the sicker populations the way they cover the new, able-bodied enrollees. But while the federal government covers 95 percent of the cost of new, healthier enrollees, they cover only 30–50 percent of the cost for the truly sick and needy.”

“Gov. LePage is correct,” Birnbaum said. “You can’t solve a long-term funding problem with one-time revenues.”

Restoring Intent

Implementing work requirements is a good idea, but full reform requires returning the program to its original intent, Birnbaum says.

“Reforms to Medicaid, such as work requirements, will have to come before expansion,” Birnbaum said. “Work requirements for entitlement programs are, in general, a good idea, but there are several problems with the current work requirements, including that they only apply to a small segment of the total recipient population and don’t really address why able-bodied people are getting benefits originally designed for low-income children, pregnant women, and the disabled.”