You may have heard of a recent tussle between two of Maine’s political leaders: Republican Gov. Paul LePage and Democratic U.S. Rep. Chellie Pingree. Pingree provoked such an uproar from LePage about the legality of Medicaid cuts that it may have been hard for people to discern what the matter was really all about: power.
Their clash was not just about Medicaid but about Pingree going over LePage’s head. In short, she undermined his authority. Courtesy and tradition in Maine call for the parties to talk to each other before acting this way, though her point was correct. Pingree should continue working to ensure that Maine abides by the Affordable Care Act and should correct LePage and Republican (or Democratic) lawmakers when they spread misinformation about the law.
Some history: Legislators knew when they passed a supplemental budget this May that they might not be able to make the Medicaid cuts they wanted. They knew that federal law prohibits states from reducing Medicaid programs to balance the budget.
But they passed a budget that included the questionable cuts anyway and said they would apply for a waiver from the Affordable Care Act, even though the director of the federal Centers for Medicare and Medicaid Services said waiver requests were unlikely to be approved. The law contains a “maintenance of effort” provision that requires states to maintain their current Medicaid coverage levels until 2014 when an expansion of the Medicaid program is supposed to take effect.
Now, however, the LePage administration is planning to take another route and apply to the federal Medicare and Medicaid centers for an amendment to Maine’s Medicaid State Plan in order to get the approximately $10 million in cuts. That route still requires federal approval, but it is more routine than getting a waiver from the health care law.
LePage was clearly angry when Pingree — without alerting him — wrote to U.S. Department of Health and Human Services Secretary Kathleen Sebelius on July 9 to say that the proposed elimination of Medicaid coverage would “be in direct violation of the (maintenance of effort) requirement, even in the wake of the Supreme Court’s ruling.”
Instead of stating reasonably why he thought he was correct, LePage shot back that Pingree is “part of big bloated government” and is “now saying that Maine should be forced to increase the burden to the taxpayers she claims to represent.” The belittling immediately changed the subject. Just as he did by referring to the IRS as the Gestapo, LePage’s outburst drove attention away from the facts of the health care law.
One such fact is that health reform could be beneficial to the nation if states do their job. For instance, adopting the health reform law’s Medicaid expansion to cover low-income parents and other adults is not expected to be a huge cost driver for states. That’s because the federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent from then on. The small increase in future state Medicaid costs is estimated to be offset by less uncompensated care being provided to the uninsured.
In his July 11 letter to Pingree, LePage ranted “that you have become part of the jet-setting Washington culture that keeps people dependent on government handouts.” He called her letter to Sebelius “careless” and added it was “astounding that you would actively advocate for the Federal Government to overrule Maine’s decisions.” Nowhere did he explain his legal argument for why the cuts should be allowed or provide proof of how the health care law would hurt Maine.
A revealing part of the letter to Pingree is near the end, when he explains how he will write to Sebelius to ask her to apply the law fairly in granting an amendment, so the state can make the Medicaid cuts. “We will certainly copy you on that letter, despite the fact it is a courtesy you have not extended to us,” LePage wrote to Pingree.
This quarrel is not just about Medicaid but about Pingree not going to LePage first to work with him. Then the question becomes: Would LePage have worked with her?
In the end, Sebelius’ interpretation of the ruling, as explained in a letter to governors, lines up with Pingree’s: The Supreme Court decided that states could not be penalized for not expanding Medicaid, but the court’s decision did not reverse a part of the law that prohibits states from cutting back existing Medicaid services.
Pingree, for her part, replied to LePage in a measured tone. “The health care reform law was debated and passed by Congress, signed by the President and upheld by the Supreme Court. It’s time to stop fighting about the health care law and start following it,” she said.
We couldn’t agree more.