May 20, 2019
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LePage fails to surprise on Medicaid expansion

Matthew Stone | BDN
Matthew Stone | BDN
Gov. Paul LePage signs a veto letter he delivered to the Legislature instantly in May after the Senate gave final passage to a bill that links repayment of Maine's hospital debt with an expansion of Medicaid.

In unsurprising fashion, Gov. Paul LePage on Monday vetoed legislation to expand Medicaid under the Affordable Care Act. We didn’t expect him to be open to the idea of extending health insurance to tens of thousands of Maine’s poorest.

We expected him, as he wrote in his veto letter, to argue that the federal government isn’t likely to hold to its promise and pay all the costs of expanding to newly eligible adults for three years — even though the legislation would end the program after three years and then require a re-evaluation. He made the postulation even though the federal government’s reimbursement rates are written into law, and Maine counts on federal commitments for many, many other programs.

We are not surprised he discussed past efforts in Maine history to extend Medicaid to low-income adults and described the effect as “running up massive debts to our hospitals” — even though the debts largely originated from a former payment system that wasn’t adjusted when more patients started visiting Maine hospitals. Can Maine cut health care costs? Of course — especially when it expands access in a way that stops costs from shifting onto those who carry insurance and improves the delivery of care.

LePage unsurprisingly says in his veto letter that the federal government is trying to “lock our earlier generosity in place,” referring to how it won’t grant full match rate funding for poor parents who the state previously agreed to cover — as if the feds would break the law to only help Maine. The federal government would continue, as it is currently doing, to pay 62 percent of the costs for that population. Overall, Maine is estimated to get a good deal: The Kaiser Family Foundation says Maine would be one of 10 states likely to save money on Medicaid over the next decade if it expands.

LePage reiterated that Maine needs to negotiate with the federal government to get a better deal. If his previous attempt is any indication of how he negotiates — asking the feds to pay for 10 years of expansion when it would clearly be against the law — we don’t have high hopes for the next proposal. Even so, if he wants to negotiate, he shouldn’t wait. The feds have already said they are ready to discuss potential strategies.

We didn’t expect rational arguments from LePage. He has not demonstrated thoughtful ideas on the issue since the U.S. Supreme Court ruled Medicaid expansion optional under the federal health reform law.

But we do expect more from GOP lawmakers who interact more closely with Maine residents and were elected, in many cases, with more support than LePage. Their constituents need them to gather their political courage and vote to override LePage’s veto. Only several more votes are needed in the Maine House and Senate to get two-thirds support.

Expanding Medicaid is an opportunity to provide health care to those who need it — to help them improve their health, productivity and overall well-being. It should be done in tandem with redesigning Maine’s Medicaid system — to focus on rewarding physicians for the value of their services, not the volume. And it should be done with a data-driven focus to track reductions in uncompensated care and emergency room use. But right now lawmakers need to pass the legislation. May they surprise Maine residents — in a good way.

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