Maine Medicaid vote could be bellwether

Backers of expanding Medicaid in Maine hope to score a victory next week at the ballot box in an end-run around their Republican governor, and success could give a boost to states looking to do the same.

Maine would be the first to expand the federal-state health program through a voter referendum. Gov. Paul LePage has vetoed five bills passed by the state’s legislature to expand coverage to more low-income adults. On Tuesday, voters get the final say. 

Backers of similar efforts in Republican-led states like Utah and Idaho are looking on keenly.

{mosads}“We’re looking at Maine as a bellwether for what’s going to happen next year,” said RyLee Curtis, campaign manager for Utah Decides Healthcare, which is leading that state’s effort. 

ObamaCare gave states the option of expanding Medicaid eligibility to more low-income adults starting in 2014, with the federal government picking up most of the cost. 

To date, 31 states and D.C. have done so.

But a number of mostly red states, including Maine, have held out, arguing the federal government shouldn’t be picking up the tab to cover childless, “able-bodied” adults who could get insurance elsewhere.

“Most of these adults do not have children, and they should be working,” LePage said in his weekly message last week.

“Then they can get insurance on the [ObamaCare] exchanges or contribute to the cost of their own health care through their employers. We don’t mind helping people get health care, but it should not be free. ‘Free’ is very expensive to somebody.”

But in states that let citizens offer referendums, there’s an opportunity to go around Republican leaders. 

In Maine, supporters needed at least 61,123 signatures from registered voters to secure a place on the ballot. The expansion would give coverage to 80,000 people. Currently, the program serves about 270,000 people, according to the Kaiser Family Foundation.  

The effort is somewhat stilted by the fact that it’s an off-election year, all but guaranteeing that fewer voters will show up at the polls. 

But a boost to their cause, advocates say, is the national spotlight Maine was under during the ObamaCare repeal debate in Congress earlier this year.

Maine Republican Sen. Susan Collins repeatedly spoke out against several repeal efforts by those in her party, citing concerns about the impact on Medicaid. She was one of three Republicans to kill the latest effort in the Senate. 

Collins has not taken a position on expansion, as is her custom with referendums, but she remains popular in the state. 

“Maine has been a focal point for the debate about health care all year long,” said David Farmer, communications director for Mainers for Health Care, the group leading the expansion effort. 

“There’s a great deal of awareness right now in the state. People are getting activated and engaged around the issue of health care, and we are working to translate that enthusiasm and that information into support and participation on Election Day.” 

Mainers for Health Care has knocked on 150,000 doors as of last week and launched five statewide television ads, in addition to participating in forums and debates with opponents, and sending out emails and direct mail. 

This year, the group has raised $1.5 million, according to state campaign filings, $750,000 of that from groups in D.C. 

They are up against a group called Welfare to Work, which has raised $410,200 this year, according to campaign documents. They are  running two statewide ads.

Regardless of what happens Tuesday, leaders of similar efforts in Idaho and Utah will be watching closely. 

“The Mainers have already given us hope that such a campaign is viable in a conservative-leaning state,” said Luke Mayville, co-founder of Reclaim Idaho, a group leading that effort. 

“Idaho’s politics are not identical to Maine’s, but there is enough similarity for Maine to serve as a model for us.” 

In Idaho, the Republican-controlled legislature has rejected Medicaid expansion several times over the years, leading advocates to take the issue to the voters in 2018. Idaho also has a Republican governor, Butch Otter.

Medicaid for Idaho is waiting for the go-ahead from state officials to begin collecting the 48,000 signatures it needs to get on the ballot. 

It’s a similar story in Utah, where conservative Republicans in the House have sank attempts to expand Medicaid, despite backing from the state’s Senate and Republican Gov. Gary Herbert. 

So activists in the state hope to get a referendum on Medicaid expansion on the ballot for next year.

“We’re very hopeful that they’re going to be successful, and I think they’ll serve as a bellwether for all of us other states working on this,” said Curtis of Utah Decides Healthcare.

National backers of ObamaCare say it’s hopeful that states are taking matters to voters directly.

“When it’s taken out of the hands of recalcitrant legislatures or governors and given to the people who think this is something that should be done, that gives a great boost to those efforts to expand Medicaid in the 18 other states,” said Patrick Willard, senior director of campaigns, outreach and engagement at Families USA, a health-care advocacy group in D.C.