Capitol Notebook: Maine Medicaid vote sets the stage for 2018 election

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In the end, the votes weren’t even close.

In a surprisingly high turnout for an off-year election, Mainers last week rendered two key decisions by large margins.

More than 80 percent of voters turned back the proposal by an international gambling entrepreneur to build a casino in York County, possibly in Old Orchard Beach.

But the most important issue decided, passing by an almost 3-2 margin, was a referendum that would expand Medicaid coverage to an estimated 70,000 Mainers.

Almost before the polls had closed, Gov. Paul LePage threatened roadblocks in the path of Medicaid expansion, which he vetoed five times. The governor said he would not expand Medicaid unless the Legislature fully funds it, and he set further requirements. And as always, his actions are backed by a band of conservative Republicans in the House of Representatives who uphold his power by backing his vetoes.

The Medicaid expansion sets the stage for a showdown between the governor and Democrats in the Legislature, a debate that will play out during the crucial 2018 campaigns that will elect a new governor and Legislature. And that fight may well end up in court, as both sides determine warfare is the best way to mobilize their base voters.

Maine last week become the 32nd state to expand Medicaid under the Americans for Affordable Care Act, which offered federal money to provide the option as a way for people who could not afford other coverage.

We were also the first state in the nation to expand Medicaid by popular vote, just the latest example of our increasing reliance on the initiative process to set policy, bypassing a divided Legislature. Republican lawmakers now say that the process of gathering voter signatures to put issues on the ballot should be made more difficult, and the next year’s session will consider efforts to tighten the rules.

The most successful architect of policy by referendum has been the Maine People’s Alliance, a liberal activist group, that successfully orchestrated last year’s minimum-wage increase. Republican House leader Ken Fredette now describes the MPA as “the Legislature’s Appropriations Committee.” MPA is now backing a petition drive that would increase taxes to fund home care for seniors.

Another group has taken out petitions to enact a “death with dignity act” to allow terminally ill patients to end their lives with the aid of a doctor. The Legislature has repeatedly refused to enact such a law.

Last week’s decisive Medicaid vote proves that a Legislature hamstrung by a Republican minority is way out of step with Maine voters.

This should be good news for Democrats in next year’s race for governor. But a trend in favor of expanding health care may not translate into victory at next year’s ballot box. It is unclear whether the primary elections, only a little more than seven months away, will use the system of ranked-choice voting that is tied up in constitutional questions and legislative objections.

The Legislature’s recent vote to stall RCV is now subject to a people’s veto attempt; if enough signatures are gathered it would suspend the Legislature’s action, and allow RCV to be used in June 2018. And June voters would also decide whether to adopt the novel system, where voters rank candidates and the results are tabulated in successive rounds until one candidate gains a majority.

But RCV vote will not be used in next year’s November election, meaning a plurality vote could win, like the 40 percent that put LePage in office. And that number mirrors the vote last week by opponents of Medicaid expansion, and probably reflects the conservative, pro-LePage base. It could be enough for Republicans in a race that will feature two strong independent candidates.

The issue of health care, and expanding Medicaid, should be an effective one for Democrats next year. But they will have to field a strong candidate, chosen from the many who have signed up for the primary. If the people’s veto is successful, and RCV is used in the June primary, it may help Democrats select a stronger candidate.

Fasten your seat belts, it’s going to be a bumpy election year.

Portland resident Marian McCue is the former editor and publisher of The Forecaster.