‘It’s Definitely Going to Happen’: Maine’s GOP Governor Can’t Stop Medicaid Expansion (Updated)

“The people rejected [LePage's] arguments and he is upset about that. He is bitter that this is his last year in office but I don’t think he should be taking it out on the people who need health care and have fought to get it.”

An activist holds a sign in support of the Affordable Care Act during a rally in D.C. on February 25, 2017. Lauryn Gutierrez / Rewire

UPDATE, April 30, 5:18 p.m.: A lawsuit was filed Monday against GOP Gov. Paul LePage’s administration for failing to expand Medicaid, as required by a successful ballot initiative, Politico reports. Maine Attorney General Janet Mills, a Democrat, didn’t say whether she’d defend Maine in the litigation brought by Medicaid expansion supporters. 

Erica LeStrange is waiting for summer. That’s when she and her wife will hopefully have access to long-awaited health care in Maine.

“I have severe nerve damage to my hands that’s why I can only work part-time,” she told Rewire. “Personal reasons aside, everyone should have access to health care and have a chance of being healthy.”

Almost 60 percent of voters in the state agreed with LeStrange’s sentiment in November when they voted to pass a ballot measure expanding Medicaid access by July 2, giving about 70,000 people access to life-saving health insurance coverage.

But Gov. Paul LePage (R), who has long opposed the Affordable Care Act (ACA), has threatened not to expand Medicaid without full funding from the Maine legislature. Health-care advocates told Rewire that LePage has no choice in the matter. 

LePage’s funding argument is moot, they said, because the federal government pays the vast majority of Medicaid expansion costs for states that participate. Republican governors have largely rejected those federal dollars, limiting Medicaid only to those on the edge of poverty. 

LePage does not have the ability to block the law, Mike Tipping, communications director at Maine People’s Alliance, told Rewire. And this is not about the money, Tipping said. 

Federal funds were earmarked for Maine three years ago to provide health insurance by expanding Medicaid coverage. Maine lawmakers passed legislation five times to approve it, but the governor vetoed each bill. The November referendum took the matter out of his hands and put it in the hands of the people.

“It’s unfortunate the governor is throwing a tantrum over this. If he breaks the law, obviously the courts will have to step in to ensure that Medicaid expansion is carried out,” Tipping said.

Tipping said restricting access to health care has become a defining issue for the outgoing governor, who has staked his reputation on it. “The people rejected his arguments, and he is upset about that. He is bitter that this is his last year in office, but I don’t think he should be taking it out on the people who need health care and have fought to get it.”

Tipping’s op-ed in the Maine Beacon calls LePage’s opposition to Medicaid expansion a “fake fight.”

Although it’s the 33rd state to expand Medicaid, Maine is the first to do it under the Trump administration, and the first to do so via a ballot initiative rather than legislation. More states with GOP-held legislatures could follow suit in 2018. 

Advocates say the issue has been long debated and that Mainers understand what the new law means for them—even though LePage has framed Medicaid expansion as a government giveaway to lazy able-bodied adults. 

“The majority of [beneficiaries of Medicaid expansion] are working; this was one of the themes over the years of debate. Over and over again people talked about their health being the key to being able to earn a living. Further, the law is expected to create about 4,000 new jobs, often in rural areas,” said Eliza Townsend, executive director of the Maine Women’s Lobby and the Maine Women’s Policy Center.

A Maine Center for Economic Policy (MECEP) analysis indicates that health-care expansion has many benefits. It would create jobs, help residents avoid medical expenses related to preventable health conditions, save hospitals money on charity care, and provide critical treatment for people suffering from substance abuse—a statewide public health crisis.

“It’s definitely going to happen,” Robyn Merrill, co-chair of Mainers for Health Care, the coalition that ran the Yes on 2 campaign, told Rewire. The most that can happen is delayed funding, she said, but Mainers will get the expansion they overwhelmingly approved. 

“People have been working far too long for healthcare coverage and there’s a real urgency in terms of their lives,” she said. “We feel really good about it. Our hope is that the administration acts to implement the law.”

Planned Parenthood of Northern New England (PPNNE) operates four health centers in Maine, and its advocacy arm, Planned Parenthood Maine Action Fund, backed the Yes on 2 campaign.

“For many patients, Planned Parenthood is their only access to care. Every day Planned Parenthood providers see the difference access to affordable, quality care makes in people’s lives. It’s a game changer,” said Amy Cookson, communications manager at PPNNE. “Maine people have spoken: they support Medicaid expansion. They know it’s good for our neighbors, our communities, and our state. Now it’s time for elected officials to implement expansion without delay so Mainers can get the care they need.”

LeStrange echoed that message.

The 29-year-old Waterville resident and hairdresser told Rewire she suffers chronic pain and has suspended treatment because she can no longer afford it. The pain is so bad she can only work two days a week and half a day at a stretch.

“I was a hairdresser, full-time, for many years until the pain became worse and worse,” she said.

LeStrange said she went through the long, complex and expensive process of getting a diagnosis under her mother’s health insurance until she turned 26, thanks to the extension granted by the Affordable Care Act under the Obama administration.

Once she aged out, her $20 co-pay became $100, and her treatment and medication became unaffordable. So she stopped, and now lives with chronic pain.

“It came down to the point with my clients that I couldn’t see them when it was convenient for them. It had to be when my hands would allow me to do the work, it had gotten so bad without being able to have access to my doctors because I couldn’t afford to pay them, and I couldn’t afford medication for treatments.”

Her wife has serious health issues, including Asperger’s and adult ADHD. Even after using manufacturer’s coupons, they are paying about $200 a month for her medications and running up medical debt. Both applied for and were rejected for state insurance because of their conditions.

The LeStranges are among the Maine voters who voted yes on Question 2.

“I’m really proud of the people of my state for doing this referendum and really letting our voices be heard,” she said. “It will take some of the financial burdens off the cost of medication and help us actually start to pay off some of the medical debt that we’ve incurred over the years. For me, it means the potential of going back to my hairdressing or other avenues of employment that have been closed off. It would just mean giving us our life back, and hopefully, preventing me from further damaging my hands.”