AUGUSTA, Maine — Gov. Paul LePage glossed over the truth about Medicaid expansion in Maine during a Tuesday morning radio interview on WVOM, according to professionals in the field.

LePage said Mainers are being misled by Medicaid expansion proponents about the provisions of the Affordable Care Act and that Maine does not qualify for the enhanced levels of federal funding available under the health care law. Under the ACA, states that expanded Medicaid in 2014 were to receive three years of 100 percent federal funding, before the federal funding rate dropped gradually to 90 percent by 2020.

In response to a question about the 90 percent match rate, LePage said, “This is a fallacy.”

“Maine did not qualify for the expansion because we expanded 15 years ago,” said LePage. “Maine did not qualify. … I don’t know why the Maine People’s Alliance continues to say we were offered an expansion. We were not. We were refused the expansion.”

LePage’s office did not respond to questions Tuesday morning seeking clarification.

LePage is correct that Maine wouldn’t receive the enhanced federal funds for a percentage of Maine’s uninsured adults. However, the state would receive those funds for a much larger population that’s eligible for Medicaid under the ACA expansion, according to a 2015 study commissioned by the Maine Health Access Foundation.

Because Maine covered parents who earned up to 138 percent of the poverty level as of December 2009, the state would not receive enhanced funding under the ACA to return those people to the Medicaid program. Currently, the federal government pays for about 64 percent of Medicaid costs and the state pays the rest.

This is what LePage was talking about on the radio Tuesday morning, though he glossed over the fact that the category of people who would not be covered under the enhanced rates includes only about 15,000 out of what proponents say would be more than 77,000 who would receive health care coverage under Medicaid expansion.

LePage, who has made the same argument based on partial information before, did not mention that approximately 56,000 newly eligible childless adults — the majority of those who would receive coverage through the expansion — would be covered under the enhanced rates.

This population, however, is the source of LePage’s ideological disagreement with the expansion.

The Republican governor has said he does not want taxpayers footing the bill for health care for what he calls “able-bodied adults,” regardless of how deep in poverty they’re living. He said many of them, partially thanks to Maine’s higher minimum wage, now qualify to purchase subsidized health insurance on exchanges created by the Affordable Care Act.

In 2013 and 2014, through initiatives spearheaded by LePage, Maine stopped its practice of providing Medicaid — or MaineCare, as it is known here — to parents who earn up to 200 percent of the federal poverty rate and some childless adults who earn up to 100 percent of the federal poverty rate.

“There is nothing wrong with asking people who are able-bodied to have skin in the game,” said LePage. “The exchanges are wonderful. They ought to have co-pays and ought to have consequences when they miss appointments or they go to the emergency room. … We can’t allow people to use the most expensive vehicles for health care when there are alternatives.”

In January, the LePage administration notified President Donald Trump’s administration that it will seek changes to the state’s Medicaid program by requesting federal permission to charge premiums and co-insurance, institute an asset test that would cut off coverage for people with $5,000 in assets, and end coverage of services incurred during the 90 days prior to a person’s Medicaid eligibility.

Emily Brostek, executive director of Maine Consumers for Affordable Health Care, said LePage, as he has in the past, is trying to gloss over the facts about federal matching rates.

“What he’s talking about there is a very small portion of the people who would be eligible for health coverage under expansion,” she said. “He’s being misleading because he’s talking about a very specific slice of the population. … The Centers for Medicaid Services has been very clear that everyone else would be eligible for the enhanced matching rate.”

Whether to expand Medicaid in Maine is a fight that has been raging for much of LePage’s time in office — he and Republican allies have turned back numerous attempts at Medicaid expansion — and it will continue to generate conflict this year leading up to a citizen-initiated referendum in November.

Virtually everything about the ACA is in question right now because of a move in Congress to repeal it and replace it with another plan. LePage said Tuesday he does not like the plan floated by House Republicans on Monday and will travel to Washington, D.C., later this week to lobby against it.

Meanwhile, Mainers will likely confront the issue this fall at the ballot box. A citizen initiative to ask Maine voters to decide the question was certified as qualified for the ballot last month by the Secretary of State’s office.


Christopher Cousins

Christopher Cousins has worked as a journalist in Maine for more than 15 years and covered state government for numerous media organizations before joining the Bangor Daily News in 2009.