Each spring my husband and I return to our Maine home, drive around this vast and wonderful state, and catch up with people we did not see over the winter. When we left last fall, one of the waitresses at our favorite diner was wondering if she could get affordable health insurance through the new national health care law. Maine’s government was dragging its feet, and at first information was hard to find. But on our return we learned she is now covered — one of more than 44,000 Mainers who have purchased a good-quality, affordable plan on the health insurance exchange. Almost all of those Mainers got credits from the federal government to help pay their premiums.
After a rocky first few months last fall, Obamacare is proving very successful. A private citizen named Charles Gaba has done the best job of keeping track of the statistics at a website, ACAsignups.net. As of June 30, 2014, Gaba estimates that between 24 and 29 million Americans have gotten new coverage — including 1.6 to 3.1 million young adults now able to stay on their parents’ health plans; 7 to 9.4 million newly insured through Medicaid; and 15.7 to 16.6 million who purchased private insurance plans meeting minimum standards on their state’s official exchange or directly from an insurance company.
Predictions of doom have not panned out. Enemies of reform said Americans would not purchase private insurance plans on the exchanges or, if they did, would not pay their premiums — but more than 8 million signed up, and at least 89 percent of them have already paid. Critics said that most signups would come from people forced to replace canceled plans, but an authoritative Kaiser Foundation study shows that 57 percent of those who purchased plans on the exchanges had no coverage before — and of course the same was true for millions who purchased other plans or got newly enrolled in Medicaid.
The Gallup poll has recorded the sharpest drop in America’s uninsured since it starting tracking the issue. Finally, doomsayers said that young adults would refuse to participate, but millions did sign up (yes, at the last minute), leaving insurance plans in good economic shape.
Year one of Obamacare was so successful that when the second enrollment year begins next November, many new plans will be offered, and prices will stay fairly stable in most states — including in Maine, where a new insurer, Harvard Pilgrim, has decided to offer plans on the exchange.
But the news for Mainers is not all good, because Gov. Paul LePage refused to cooperate with the second major part of health reform — the expansion of Medicaid to cover men and women whose low earnings put them just above the poverty line. If LePage had accepted one of several bipartisan expansion plans approved by legislative majorities, new Medicaid coverage would have become available in 2014 to up to 70,000 more low-income Maine residents, including an estimated 24,390 people who have no other options to get coverage. Until 2020, the federal government would pay 100 percent of the cost (and 90 percent after that).
LePage’s repeated vetoes hurt more than just uninsured Mainers. The Maine Hospital Association and many business groups have endorsed Medicaid expansion because they know it is just plain dumb to turn away federal dollars that would, according to the best estimates, create some 4,400 new jobs, boosting the state’s paltry employment growth. As it is, Maine taxpayers are essentially sending money to other states to cover their uninsured, to help the bottom lines of their hospitals and to expand their businesses.
Recently, I attended a postcard show in Searsport and found a 1956 card with President Dwight D. Eisenhower pictured on the front and a list of 10 reasons he should be re-elected on the back. The usual GOP appeals appeared: tax cuts, reductions in government “regimentation,” and effective foreign policy. But I was struck by the emphasis on Eisenhower as a peacemaker who “ended the Korean War and has kept America out of war.” And I found even more remarkable the pride with which Eisenhower’s re-election campaign bragged that “he has increased welfare and security programs and is promoting the well being of Americans” and “has been a President for all Americans — regardless of political affiliation, race, creed, color, or economic background.”
Eisenhower was a moderate Republican — just like members of his party have long been in Maine. Think of Margaret Chase Smith, William Cohen, Olympia Snowe and Susan Collins, all of whom have been willing to work out compromises with Democrats to serve all citizens. But things surely have changed now that LePage and his tea party faction have taken center stage. A man of explosive temper and many hatreds, LePage outright refuses to work with Democrats and Republicans of other political persuasions to serve all of the state’s people; and he seems to spend much of his time attacking other politicians and denigrating minorities and poor people.
In health reform, above all, Maine should be leading the way. It shouldn’t just sign up as many of its economically struggling citizens as it can but propose adjustments and innovations to make health reform work well in a state with many small businesses and a need to deliver high-quality, cost-effective care in poor urban areas and far-flung rural communities. In more than half a dozen other states, Republican governors and legislators have accepted Medicaid expansion while also proposing conservative reforms that the Obama administration has accepted. In a similar way, Maine Republicans could have carried through bipartisan Medicaid reforms, and Maine’s congressional delegation could work across party lines to improve the national Affordable Care law. Tea party extremism in the Republican Party and angry vetoes from LePage cut off these possibilities.
Before long, moderate Republicanism and the spirit of compromise may again hold sway in Maine, allowing moderate Democrats and Republicans to work together. This fall, voters have the chance to insist that the Pine Tree state take its full share of health reform dollars and spend them wisely to help Maine workers, health care providers and businesses flourish. The time has come for Maine to stop lagging and start leading.
Theda Skocpol is the Victor S. Thomas Professor of Government and Sociology at Harvard University and the national director of the Scholars Strategy Network.