In November, a majority of Maine voters said they wanted to expand Medicaid in their state, a critical step toward becoming the first state to do so through popular vote.
But one man presents a significant roadblock: the state's governor, Paul LePage. LePage, a Republican, vehemently opposes expansion under the Affordable Care Act. He says the state lacks the money to pay for it, since the ballot initiative was passed without a funding mechanism, and warns that the expansion could threaten services for people with disabilities and the elderly.
As a rural state with low wages and an aging population, Medicaid expansion would provide coverage to some 70,000 additional Mainers, starting July 2. For many, this would mean greater access to physicians and services like opioid addiction treatment and cheaper prescription drugs. Under ACA guidelines, Medicaid expansion now covers people who earn up to 138 percent of the poverty line. That means individual Maine residents who earn up to $16,642 or a family of four earning up to $24,600 would qualify.
During his seven years in office, LePage has vetoed five separate Medicaid expansion bills that the Maine Legislature has sent to his desk. This time, the voter-approved ballot is veto-proof. However, the Republican-controlled Legislature, and LePage himself, could alter the wording and scope of the final legislation, according to the Bangor Daily News.
"I don't believe for one minute that health care is a right," LePage told PBS NewsHour special correspondent Sarah Varney. "In my lifetime, I've made health care a priority for myself and my family."
Throughout his political career, LePage has been an outspoken critic of government safety net programs, and is a leading Republican voice in the movement that calls for people to prove that they need government aid. For example, LePage amended Maine's food stamp program to require that applicants submit an "asset test" to determine the extent of one's need.
LePage's childhood shaped his belief in personal responsibility and the role of government. One of 18 children, LePage was homeless by age 11 and credits his "education and hard work" for getting off the street and ultimately into the Governor's Mansion. He views his own success as proof of hard work as a virtue and believes that "able-bodied people" should rely less on social programs and more on their own work ethic.
"We're asking hardworking Maine families to pick up the extra tab for people who should be working, but elect not to," LePage said. "People have to provide, have to contribute to the well-being of not only their household, but society as a whole. If you choose not to participate, then I don't think it's government's responsibility to pick up the tab."
LePage's opposition puts him at odds with the 59 percent of Maine voters who in November voted for the Medicaid expansion. Currently in Maine, 264,077 residents receive coverage under the program. LePage also faces opposition from within the Legislature, including Speaker of the House Sara Gideon, a longtime advocate for expansion.
"Mainers want more access to health care, not less, and are no longer willing to wait," Gideon said in a statement after the November vote.
In an interview with the NewsHour, Gideon added: "When more people are actually insured, when they have access to health care, when they are able to go to the doctor without it being charity care, then everybody's costs go down."
LePage has vocally supported ACA repeal efforts and criticized Maine's two senators for not backing the Republican attempt to repeal the law over the summer. U.S. Senator Susan Collins, a Republican from Maine, was one of the three Republican votes that ultimately sank the bill. After the vote, LePage wrote an op-ed for the Wall Street Journal calling the votes by Sens. Collins and Angus King "downright dangerous."
LePage also characterized Maine's Medicaid expansion in 2002 under then-Gov. Angus King as a "financial disaster." The 2002 Medicaid expansion was funded by a cigarette tax increase.
"We ended up owing our hospitals $750 million of unpaid bills," LePage said. "Many nursing homes were forced to close. Unless they find a sustainable funding mechanism, we're heading for another disaster."
In a Dec. 11 letter to the state Legislature, LePage outlined key principles he vows to follow given the implementation. These include no tax increases on families or businesses to pay for expansion. His administration also estimates the price tag will be twice what the Legislature's nonpartisan fiscal office has projected.
In an interview, LePage was adamant that he will not ignore the will of the voters, and said he has "no problem" implementing the law, given there is funding for expansion. But he added: "I don't have to implement it until the money is in play."
Robyn Merrill, executive director of Maine Equal Justice Partners, an advocacy group that played a pivotal role in getting the initiative on the ballot, says the governor has no authority to block the measure.
"This is now the law, and the governor can't veto the law, he can't change the law," she said. "He doesn't have the authority to do that."
Editor's Note: On the NewsHour tonight special correspondent Sarah Varney reports on the battle over Medicaid expansion in Maine.