Why Maine's governor and voters are in a fight over Medicaid expansion
Hari Sreenivasan: The battle over repealing the health care law occupied much of the national political agenda this year.
The individual mandate for coverage was repealed through the tax bill starting in 2019. But Republican efforts to repeal the expansion of Medicaid failed, at least for now.
Yet, even as that debate played out, voters in Maine overwhelmingly approved a ballot measure last month to expand Medicaid there to most low-income adults. The victory has reinvigorated advocates looking to expand Medicaid in other states.
But as special correspondent Sarah Varney reports, the battle is not yet over in Maine.
Our story was produced in collaboration with our partner Kaiser Health News.
Sarah Varney: Donna Wall cares for her three adult autistic children at her home in Lewiston, Maine. It's a full-time job. Her sons Christopher and Brandon have frequent outbursts, and the stress of tending to them can be overwhelming.
When her sons turned 18 a year-and-a-half ago, Maine's Medicaid program dropped her health insurance. Wall is considered a 'childless adult' in Maine and other states that didn't expand Medicaid, and so she isn't eligible for coverage. She can no longer get her anti-depression and anxiety medications. She can't see her psychologist or a doctor to check up on a troubling spot on her eye.
She needs to stay whole, she says, for her kids.
Donna Wall: I'm 60 years old. Things start going wrong when you get older, and I haven't had a Pap smear or breast exam in two years. I'm just worried something will happen to me, because who is going to take care of them? It's a big job. It really is.
I mean, if I put the boys in a home, it would cost the state a lot more to take care of them than it would be to pay my medical.
Sarah Varney: Even on frigid, wintry nights, Wall delivers newspapers, earning $150 a week when her kids are asleep.
Donna Wall: I go out about 2:00 in the morning. And it usually takes me four to five hours. And I try really hard not to fall, but I have had a few accidents. One of them was on black ice last winter.
Sarah Varney: At one point, Wall thought she might have broken a rib. But she stayed away from the emergency room for fear of a costly medical bill.
At least 70,000 low-income Maine residents, like Donna Wall, should gain Medicaid health insurance because of the ballot measure that passed last month. Advocates collected signatures to put the question to voters, and, in November, Maine became the first state to get approval at the ballot box to expand Medicaid, passing with 59 percent approval.
But even though voters here in Maine decided to expand Medicaid, the law's fate is still unclear. Republican Governor Paul LePage says opening up the program to more poor adults threatens the state's financial stability and that lawmakers shouldn't raise taxes to pay for it.
Gov. Paul LePage: You have to pay for the law. It's going to cost money. And I intend to implement it, and the legislature is required to fund it. If they do not fund it, it will not be implemented.
Sarah Varney: LePage has been in power for seven years, and, because of term limits, is heading into his final year in office. He vetoed five Medicaid expansion bills passed by the legislature before voters approved it at the ballot box.
LePage says lawmakers must now pay for the new law without raising taxes or dipping into the state's rainy day fund. And he warns that the expansion could threaten services for people with disabilities and the elderly.
Gov. Paul LePage: When able-bodied people, who are able and should be working, choose not to work, then I don't think it's society's responsibility to cover their insurance at the expense of our mentally ill, our disabled, and our elderly.
We're asking hardworking Maine families to pick up the extra tab for people who should be working, but elect not to be.
Sara Gideon: Wow, well that's just simply not true.
Sarah Varney: Sara Gideon, a Democrat, is the speaker of Maine's House of Representatives.
Sara Gideon: Let's start with the population of people who will actually be eligible for health insurance now. We're talking about people, almost 70 percent of whom are people who are actually in the workforce, who are earning a living, but not actually able to afford health care with the low income that they earn.
Sarah Varney: Gideon says LePage must follow the law. Moreover, she's confident the legislature will find a way to fund the state's share of $54 million and keep its promises to the elderly and disabled.
Sara Gideon: It's not a choice between people, one group of people over another. It's a false choice that this governor is trying to present. And we say, we're not going to make that choice. It is the law. And we're simply going to make sure that that law is implemented.
Marie Vienneau: Our rural hospital is struggling. We don't make money. We lost a million-and-a-half dollars the last two years.
Sarah Varney: Marie Vienneau, CEO Of Mayo Regional Hospital in Dover-Foxcroft, says money from the Medicaid expansion can't come fast enough. Maine's rural towns and their hospitals have been hard-hit. Factories have closed and many residents have moved away.
Marie Vienneau: We're going to go by what was Moosehead Manufacturing. They made furniture that was very well known throughout the country, as well as Dover. And then, of course, paper mills were huge in all of this area.
Sarah Varney: As workers lost their jobs, more uninsured patients turned to rural hospitals desperate for medical care but unable to pay. While Mayo is facing financial uncertainty, at least three rural hospitals in Maine have closed in recent years.
Deanna Chevery was laid off after 25 years when the Dexter Shoe factory closed in Dexter, Maine. Now 60 years old and uninsured, she's recovering from an addiction to pain pills prescribed by her doctor for back pain.
She overdosed five times, costing Mayo Regional Hospital over $200,000 in unreimbursed care. Before Chevery found the charity recovery program at Mayo Regional, she says she was turned away when she sought help because she couldn't pay.
Deanna Chevery: You can only go so many places. Nobody will take you. I mean, they don't care if you're crawling on the ground. I'm just fortunate Dover helps me.
Sarah Varney: But Vienneau says the hospital cannot keep up with Maine's growing opioid epidemic and ever-rising costs without expanded Medicaid.
Marie Vienneau: You can only go so many years in a row where your business doesn't lose money, before you depreciate to the point that you have to start closing services, decreasing services. And then access goes away.
Sarah Varney: Medicaid advocates, like Maine Equal Justice Partners, are pressuring lawmakers to put the new law into effect quickly.
Robyn Merrill: The law's on our side. The facts are on our side. The reality of people's lives are on our side. Did I say the law is on our side?
Sarah Varney: Victoria Rodriguez says people like Donna Wall, with her autistic children, need help quickly.
Victoria Rodriguez: It's really stressful to hear these stories from people who are literally just one accident away from being buried in medical debt and their families being devastated by that.
Sarah Varney: The group has been receiving postcards from around the country congratulating them on becoming the 32nd state to expand Medicaid.
Chris Hastedt: So, this one's from Virginia. "Greetings from Virginia. Thanks, y'all, for your efforts. The majority of voters in Maine have resoundingly approved expanding Medicaid for 70,000 low-income people. Wahoo!"
Sarah Varney: And advocates in many other red states that refused to expand Medicaid are eying their own ballot measures, including Nebraska, Utah, Idaho, Florida, and Missouri.
Patrick Willard, a senior director at Families USA, a progressive advocacy group based in Washington, says after years of Republicans attacking the Affordable Care Act, voters are beginning to shift their views.
Patrick Williard: What we have heard is that other states suddenly see an opportunity now to figure out a way that they can get around legislatures that have been holding this up.
Sarah Varney: As state lawmakers in Maine work out the details of the new law, many disagree with LePage about how much it will cost. His administration estimates the price tag will be twice what the legislature's nonpartisan Fiscal Office has projected.
LePage says, if they can't resolve the impasse, he will take legal action, if necessary.
Gov. Paul LePage: We will go to court, because I know — listen, one thing that I know better than the legislature is financial responsibility. And I have proven it over the last seven years.
Sarah Varney: Advocates say those who are eligible for Medicaid could enroll as early as this summer. But if there are delays, they too will sue.
Just days after our interview, Donna Wall fell during her middle-of-the-night paper route and broke her ankle. She still doesn't have health insurance and is unsure how she will care for her autistic children and uncertain what the future will bring.
For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney.