Policy Wonk: Voter initiative should decide Mainecare expansion

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An obstinate governor and an ideologically driven Republican minority in the Legislature are on the cusp of again blocking Maine’s participation in the Affordable Care Act, a participation that would provide health insurance to some 60,000-70,000 low-income Mainers, and pour hundreds of millions of federal dollars into Maine’s economy over the next three years.

Whether one looks at LD 1578 in terms of the health-care benefits it would provide to some of Maine’s least well-off residents – benefits that will improve the quality of their lives, and life expectancy itself – or in purely economic terms (the beneficial multiplier effect of putting nearly a billion dollars into Maine’s economy), the refusal to participate makes no sense.

Undisputed data published by the Maine Center for Economic Policy indicates that over 4,000 health-care related jobs would be created by this cash infusion into our economy. Every hospital and county in the state would benefit.

But the naysayers are about to prevail. No, to health care for Maine’s poor; no, to Maine’s economy; no, to Obama.

The irrationality here is mind boggling.

The legislative package this year was largely tailored by Republicans (Sens. Roger Katz, R-Augusta, and Sen. Tom Saviello, R-Wilton) to meet past Republican objections. It requires that cost-saving managed-care approaches be taken with all (existing and new) Mainecare beneficiaries; it allows the state to opt out if health-care cost savings are not realized over the next three years, and/or if the federal government (after fully funding ACA participation for the first three years) reneges on its 90 percent funding commitment for following years.

But still, the legislation is a step from defeat, again.

Given this level of obdurateness, if Mainecare expansion is in fact defeated, a different strategy is called for. It’s time for a broad coalition of nonprofit citizen groups (those who speak for doctors, nurses, hospitals, organized labor, the handicapped, the poor, the elderly, minorities) to join forces and utilize the initiative processes provided in the state Constitution.

This coalition would have the muscle to quickly gather the necessary signatures, to put the Katz/Saviello bill (as is) before the voters at the upcoming November election. Let the citizens choose not only a governor and the next Legislature, but whether Maine should participate in the ACA, thereby meeting the needs of thousands of Mainers without health insurance, and simultaneously giving Maine’s economy a much-needed shot in the arm.

I can see my Democratic friends squirming at this point. I have urged them to take this issue to the voters for almost two years . They have always resisted: the timing wasn’t right, or we can swing some moderate Republicans, or it’s a costly undertaking, or we need to focus on winning legislative seats and the governor’s office in November.

My response: not participating in the ACA is the most costly mistake Maine has ever made, and winning the initiative will bolster your chances to win legislative seats and the governor’s office.

But Democratic leaders, Republicans, and independents running for office this November must decide for themselves whether to support an initiative that would enable Maine to participate in the ACA. The success of the initiative approach I am urging does not require the support of any of these political groups or individuals; the ACA ball has been in the hands of politicians long enough, and they’re on the verge of dropping it, again.

The initiative I am urging requires a broad-based, grassroots coalition of groups and individuals who need, want, and will benefit from Maine’s participation in the ACA. The leadership of these groups need to get their heads together and begin the process. It’s not rocket science, it’s people power, legwork and persistence.

The most recent model is the group that came together to defeat LePage’s voter suppression efforts in November 2011. The signatures were gathered in record numbers in record time, and 60 percent of the voters repudiated this Republican assault on democratic values.

A similar vote is possible on the question of whether Maine should participate in the ACA. Those who want participation in the ACA need to begin organizing, and get the initiative process rolling now.

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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 orlando.delogu@maine.edu.