Governors across the country are holding their breaths as they wait to see how Congress might change Medicaid as part of a repeal of Obamacare.
But Maine has a special concern. It could get hit with big bill for expanding its Medicaid program to some 64,000 people just as Congress makes it dramatically less advantageous to pull the expansion trigger.
“It’s a huge financial burden down the road. And why would the federal government want us to do that?
Republican Gov. Paul LePage has vetoed six separate attempts to force the state to expand coverage under the Affordable Care Act. In November, however, voters could bypass the governor and approve an expansion by referendum.
That has LePage, who worked to pay of $750 million in unpaid Medicaid bills to the state’s hospitals, fearing that his state might face a new financial headache. Obamacare initially offered to cover new enrollees earning between the poverty line and 138 percent of that threshold with no cost to states in 2013, 2014 and 2015. After that, states gradually begin paying a share that rises to 10 percent in 2020.
But under the proposed American Health Care Act, states that want to keep expanded coverage would have to do so at the normal federal-state matching ratios for poorer Medicaid recipients. Those matches vary based on each state’s wealth, raging from a 50 percent to 75 percent federal match. Maine would have to kick in 37 percent for each recipient.
“It’s a huge financial burden down the road,” LePage told LifeZette in an exclusive interview. “And why would the federal government want us to do that?”
States that took the early free money may now be regretting their decisions now that state governments are having to start chipping in, LePage said.
“They’re all bleeding red now,” he said. “They’re just starting to feel the pain now.”
LePage was in Washington meeting with Health and Human Services Secretary Tom Price and other administration officials pushing his request that President Donald Trump support freezing Medicaid coverage in place as part of the health bill.
That would mean that whether a state expanded or not, it could not change coverage going forward. That effectively would make the referendum in Maine null and void.
LePage said he had a sympathetic audience but won no commitments.
“Everybody is receptive to listening,” he said. “I don’t know if it will lead to any results.”
LePage said he also supports changing Medicaid to require able-bodied recipients to work.
“We believe the goal should be making sure they do get jobs and get commercial insurance,” he said.
Some states sought waivers from the federal government during the Barack Obama administration that would have included work requirements as part of Medicaid expansion. But the administration rejected those requests and proposed waivers that would have required poorer recipients to make co-pays.
But LePage said he is confident that the Trump administration will be more open to experimentation.
Advocates who got the issue placed on this November’s ballot in Maine argue that the state should not allow the current congressional debate to deter the state from expanding coverage under the current terms.
“We don’t know what that’s going to look like,” sad Robyn Merrill, executive director of Maine Equal Justice Partners and a spokeswoman for Mainers for Health Care, according to the Portland Press-Herald. “What we do know is the option is there for Maine right now, and say there was a change at the federal level, and the voters pass this in November, it would come back to the Legislature, just as the Legislature is right now looking at referendums that passed in 2016.”