Policy Wonk: Refusing to fund Maine’s Medicaid expansion is fiscal madness

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If a wealthy uncle offered to contribute $10 for every dollar you contributed to repair your house, who among us would turn down the offer? Only a fool.

That’s the deal the Affordable Care Act has put on the table: $525 million federal dollars will be provided to the state of Maine annually to expand health insurance coverage to an additional 80,000 Mainers, if we commit to bearing not more than 10 percent of the ACA Medicaid expansion costs (estimated at $50-60 million annually). The deal extends to fiscal years 2019 and 2020, and every year thereafter as long as these ACA funding provisions remain in place.

This money would filter into hospitals and individual health-care providers in every corner of the state. It would sustain and expand needed health-care jobs. It would obviate the need for the poor and uninsured to turn to high-cost emergency-room care when faced with medical emergencies.

It would allow low-income Mainers to have the benefit of meaningful health insurance coverage; routine and preventative health care that improves the quality of life and extends the life expectancy of these individuals.

But we have our fool. Gov. Paul LePage has claimed the mantle.

For five years he has blocked legislatively adopted ACA Medicaid health insurance for low-income Mainers. Ideologically driven Republicans in the Legislature have sustained five vetoes of legislation authorizing participation in this program. We have foolishly foregone hundreds of millions of federal dollars

Thirty-one other states have participated in this program, but LePage and Republicans in the Legislature were unmoved, despite the fact that during the first three years of the ACA, the federal government would bear the full cost of expanded Medicaid health insurance.

Maine has lost these federal dollars forever, along with the economic and health-care benefits (and the multiplier effect) that these dollars would have created; the elderly, poor, and rural hospitals suffer most.

Facing this political stalemate in Augusta and the accompanying economic malfeasance and human harms produced, a citizen initiative to expand Medicaid insurance in Maine (similar in substance to the vetoed legislation) was passed overwhelming by voters in November.

But the governor – ever the fool – threatens not to implement this constitutionally authorized enactment by requiring the Legislature to fund (up front) the state’s share of first-year ACA insurance expansion costs, which he estimates to be $60 million. And he provides no data indicating that $60 million is an accurate first-year state cost.

Further, he charges the Legislature to find this sum without raising taxes; without reaching into the state’s surplus account; without cutting state appropriations for schools, and without reducing any budgeted expenditures linked to social services or Maine’s economy.

These actions by the governor are impermissible; he has no constitutional authority to indirectly veto an approved initiative, or to impose implementation limitations and duties on the Legislature.

On the contrary, Maine’s Constitution explicitly states that “the Governor shall take care that the laws be faithfully executed”; that “any measure referred to the people and approved by a majority of the votes given thereon shall … become a law …,” and that “the veto power of the Governor shall not extend to any measure approved by vote of the people.”

Moreover, Maine’s highest court in dealing with voter-approved initiatives has repeatedly made clear that they “… must be liberally construed to facilitate, rather than to handicap, the people’s exercise of their sovereign power to legislate,” and that “the right of the people … to enact legislation … is an absolute one and cannot be abridged directly or indirectly.”

The governor is free to work with the Legislature to raise taxes, allocate rainy day funds, reduce any or all present expenditure commitments (or a combination of these measures) to meet the state’s actual annual share of participation in ACA Medicaid expansion growing out of the initiated law.

But he has no back-door veto power of this law. His sole duty at this point is to “facilitate, rather than to handicap,” the initiated law. He must be held to this duty by the attorney general and/or by the Legislature.

The fool’s errand imposed on the state – foregoing hundreds of millions of federal dollars annually – has been ended by the people.

Orlando Delogu of Portland is emeritus professor of law at the University of Maine School of Law and a longtime public policy consultant to federal, state, and local government agencies and officials. He can be reached at orlandodelogu@maine.rr.com.