Maine Governor Paul LePage could thwart rollout as state becomes first to approve Medicaid expansion through public vote

Credit: Gage Skidmore.

Maine Gov. Paul LePage on Wednesday said he will fight a voter-approved Medicaid expansion unless it is "fully funded," even though the federal government would pay for 94 percent of the expansion costs under the Affordable Care Act.

LePage, who has numerously vetoed such legislation, said the state's Legislature must come up with a funding plan, according to the Portland Press Herald.

[Also: Paul LePage says he will create a healthcare system for Maine so it can exit Obamacare]

Maine voters on Tuesday overwhelmingly approved a citizens initiative to expand Medicaid for 70,000 low-income residents in the state, even as federal lawmakers and administrators work to weaken or dismantle Medicaid expansion that has allowed millions to get healthcare coverage and brought relief to hospitals by lowering uncompensated care.

Idaho and Utah have launched similar efforts in those states to get Medicaid expansion on the 2018 ballot.

LePage claims that the last time the state had Medicaid expansion in 2002 it created a $750 million state debt to hospitals and resulted in budget shortfalls.

The Maine vote, as well as the election of numerous Democratic candidates Tuesday, is seen both as a public rebuke of President Donald Trump's administration and a cry of support  for the Affordable Care Act.

The Maine Hospital Association supported the expansion referendum as the best means to provide access to health insurance coverage.

However, the MHA also expressed concern about the measure moving forward by citizens' petition, in a statement that came close to foreshadowing the results.

"Ultimately, there is no way to responsibly or fairly implement policy changes without going through the Legislature itself," the MHA Board of Directors said by statement in late September.

Hospitals support Medicaid expansion because it represents the only viable option for coverage for many low-income residents, the MHA said.

"Second, the pool of federal funding that is available to Maine to cover the vast majority of the costs of expansion resulted, in part, from Medicare cuts imposed on hospitals in the ACA," the board said.  "Without expansion, hospitals in Maine continue to suffer the pain of those cuts without the corresponding gain from expansion."

Also, Maine's administration and lawmakers have taken past actions that have reduced reimbursement to hospitals in the Medicaid program, resulting in hospitals receiving $60 million a year less than they did four years ago.

Maine hospitals operated on an aggregate 0.3 percent operating margin in 2016, the MHA said. About 19 operate in the red.

"Charity care costs for uninsured poor Mainers cost hospitals over $100 million per year," the MHA said.

With Maine, 32 states and the District of Columbia have approved Medicaid expansion.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com