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Jennie Pirkl campaign manager for Yes on 2 announces victory at Bayside Bowl Election day in Portland Tuesday, November 7, 2017. (Staff photo by Shawn Patrick Ouellette/Portland Press Herald via Getty Images)

Why Maine voted to expand Medicaid — and what’s next

For the past two years, Tina Brierley has earned minimum wage in the office of a woolen yarn mill near her home on a hill in Harmony, Maine.

At 59, Brierley still has six years before she qualifies for Medicare. So she buys her insurance on the individual marketplace through the Affordable Care Act. Each month, she spends a quarter of her paycheck on a $322 health insurance bill.

The former anesthesia technician spent most of her career at a hospital in Burlington, Massachusetts, before she and her retired husband moved back to her home state for the clear night skies and a slower pace of life, but she also needs to make ends meet. Harmony is rural, and jobs are scarce, Brierley said. “Where I am, people are a dime a dozen, and people certainly treat you that way,” she added.

On Tuesday, Brierley joined 59 percent of Maine voters who said they wanted to expand Medicaid — the first time the question of whether to expand the health program has been put to voters. Voters in Idaho, Utah and Alaska will face similar referendums in the coming months.

The option to broaden the program for the low-income, elderly and disabled was made available to states through the passage of the Affordable Care Act in 2010. Since 2014, 31 states and the District of Columbia have expanded Medicaid through Obamacare. But, until Tuesday’s vote in Maine, the decision had been made by state legislatures.

Now, state lawmakers are expected to extend Medicaid through MaineCare to those under the age of 65, and to those with incomes equal to or below 138 percent of the poverty line — even as some Republican leaders, including Gov. Paul LePage, are pushing back.

LePage rejected the vote’s outcome, calling Medicaid expansion “fiscally irresponsible” and “ruinous to Maine’s budget.”

“My administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated,” LePage said in a written statement. “I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.”

But House Speaker Sara Gideon said, “Mainers demanded affordable access to healthcare yesterday, and that is exactly what we intend to deliver.”

“The legislature will move swiftly to fund Medicaid expansion as required by law. The governor and DHHS commissioner will implement its requirements as well, as they are obligated to do. Any attempts to illegally delay or subvert this law will not be tolerated and will be fought with every recourse at our disposal,” she said in a statement.

More than 267,000 Mainers are covered by Medicaid and the Children’s Health Insurance Program in a state with 1.3 million residents, according to Kaiser Family Foundation. Under expanded Medicaid, 70,000 more people would gain health coverage, the Associated Press reported.

States who have decided to expand Medicaid receive additional federal funding to cover more patients through the program. Since 2014, the federal government has agreed to continue that funding until 2020. Before this week’s vote, 19 states, including Maine, had chosen to forgo that funding.

Opponents to expansion, including LePage, point to an analysis from the state legislature’s Office of Fiscal and Program Review that shows Medicaid for more Mainers would cost $54 million a year, a price tag he says the state cannot afford. LePage has vetoed five separate attempts by Maine state legislators to expand Medicaid, the Associated Press reported. The federal government would be responsible for $525 million, according to the Maine Office of the Secretary of State.

LePage has vetoed five separate attempts by Maine state legislators to expand Medicaid, the Associated Press reported.

Brierley said she “can’t imagine not having health insurance.” She is looking for jobs that offer benefits, but if hired, she would have to drive an hour from her home each day to get to work. If Brierley qualified for expanded Medicaid, she said she’d enroll in it.

“It’s a scary thing,” she said. “It’s so expensive, and (health care finances) shouldn’t dictate my life.”

In the town of Vinalhaven, 75 miles and a ferry ride away from Brierley’s home, Dinah Moyer directs Islands Community Health Services, a federally qualified health care center that offers medical, dental, mental and behavioral health care and ACA enrollment to about 1,450 people a year, including the island’s influx of seasonal summer residents.

The center sits on an island 15 miles off Maine’s coast, in the middle a lobstering and fishing community that thrives off the latest catch pulled from the Atlantic Ocean. About 1,200 people call Vinalhaven home.

There, the center’s 23 staff members treat patients for everything from diabetes, hypertension and depression to trauma, sore throats and heart attacks, Moyer said. Many patients cannot pay for these services, but the center won’t turn anyone away. As a result, she said the center works at an operating loss and writes off about $250,000 in payments they will never receive each year. Under the expansion, “we’d be able to bill Medicaid for them.”

In Vinalhaven and across the state, Moyer said she supported this expansion so long as federal funds could help remove barriers to care. But Moyer said threats from the Trump administration to cut millions from Medicaid nationwide concerns her.

“It’ll be overall really good for the state,” Moyer said, adding many Mainers “haven’t been accessing health care because they can’t afford it.”

The legislation would take effect 30 days after LePage declares the election’s official results, according to the Office of the Secretary of State in Maine. The state then has 90 days to submit its expansion plan to the Department of Health and Human Services. Emma Sandoe, a health policy doctoral student at Harvard University who worked at the Centers for Medicaid and Medicare, has studied the Maine vote and said governor could say the state doesn’t have enough money to fund the measure, signaling this issue is far from over: “Maine has a history of slow walking initiatives in the state and failing to implement them all together,” she said.

Federal threats to scale back Medicaid, along with rhetoric from the capital in Augusta, worries Mainers who voted for expansion. One of those state legislators, Sen. Troy Jackson, called Tuesday’s vote “a win for the little person, finally.”

When asked about LePage’s rejection of Maine’s vote while accepting government-provided healthcare, Jackson said that was “the most unbelieveable scumbag thing I’ve ever seen. It comes down to other people deciding who else is worthy.”

A Democrat who represents Allagash and part of northernmost Maine that borders Canada, Jackson, the state senate minority leader, said expanded Medicaid would offer support to struggling rural hospitals in his state while opening access to addiction treatment as the state combats the opioid crisis. But Jackson said he expects a long fight ahead.

“Healthcare’s getting out of reach for more and more people,” he said. “Even people who have health care feel they’re going underwater every day.”

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