EDITORIAL: Is LePage really such a stalwart opponent of Medicaid expansion?

May 26--Gov. Paul LePage is an avowed opponent of Medicaid expansion. But does he really understand the impact of his decision?

We have our doubts after the governor's Monday appearance on Maine Public Broadcasting Network's "Maine Calling." During the hourlong call-in show, the governor demonstrated embarrassingly little understanding of Maine's health coverage landscape.

Apparently, after signing a state budget early in his tenure as governor to cut back on Medicaid coverage for low-income adults without children, then nixing expansion bills that would restore coverage to that exact population, the governor still thinks Medicaid coverage is an option for childless adults, whose income is 138 percent of the federal poverty level -- about $21,300 for a two-person household -- or lower.

The governor betrayed his lack of understanding after "Maine Calling" host Jennifer Rooks asked him about health coverage for low-income people caught in Maine's coverage gap -- those who don't qualify for Medicaid but have incomes too low to qualify for subsidized health insurance through the Affordable Care Act's online marketplace.

"The state of Maine right now is at 200 percent [of the federal poverty level], which is above what Obamacare says at 138," LePage replied. "We are providing everything that we can by law. We're following the law. Expanding Medicaid isn't going to help those folks, because they don't qualify anyways. That's the problem people don't understand is, they don't qualify, because we're already above the 138. We are already paying above 138. We were not allowed to go to 100 percent."

If that's actually LePage's understanding, he has apparently forgotten everything that has happened with Medicaid coverage during his time in office. Here's a timeline to refresh the governor's memory:

-- When LePage took office, the state's Medicaid program, MaineCare, offered coverage to parents with dependent children who earned up to 200 percent of the poverty level -- about $40,000 for a family of three. Limited coverage was available to adults without children whose income fell below the federal poverty level.

-- In 2012, LePage signed a supplemental budget bill that proposed to scale back the coverage threshold for parents to 100 percent of the poverty level and ultimately end coverage for childless adults.

-- The problem was, the cuts to parent coverage ran afoul of federal law, specifically a provision of the Affordable Care Act that required that states generally keep their Medicaid programs unchanged until 2014. Ultimately, Maine was allowed to trim parent coverage back to 138 percent of the poverty level, not the 100 percent level sought by the LePage administration. The administration wasn't allowed to cut off coverage to about 6,000 low-income 19- and 20-year-olds, either -- a denial that LePage unsuccessfully attempted to take to the Supreme Court.

-- At the start of 2014, the LePage administration was able to lower the coverage threshold to 100 percent of the poverty level for parents. Low-income childless adults also lost their coverage at that time, as Maine's special arrangement for covering them expired. A Medicaid expansion bill would have spared both populations from coverage cuts, but LePage vetoed expansion legislation.

Today, Maine offers no coverage to low-income adults without children and covers only parents with incomes below the poverty line. But LePage apparently thinks many more Maine residents qualify for Medicaid.

When a listener called in Monday and challenged LePage on his Medicaid misunderstanding, LePage doubled down. The caller said her income was low enough to qualify for Medicaid. Since Maine hadn't expanded coverage, though, she couldn't sign up for coverage.

"When I leave here, I'm going to go call the commissioner to see," LePage said. "There's something missing here, because that's the whole purpose. Medicaid are for those below the 138 level, and they get Medicaid."

Indeed, that's how the Affordable Care Act was designed -- to cover those with the lowest incomes with Medicaid, then subsidize private insurance for those with higher incomes. But since LePage has refused to expand Medicaid, the coverage continuum isn't working the way he think it's working.

The exchange got us thinking: Is LePage really such a stalwart opponent of Medicaid expansion, or has he been misunderstanding Medicaid this whole time? It would be shameful if thousands of Mainers were going without health coverage because of LePage's ignorance.

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