EDITORIAL: Medicaid expansion should be top priority as legislators get back to work

Jan. 05--Now that the Legislature is back in session, lawmakers will face hundreds of bills and big financial questions. But three issues demand action, namely because the people of Maine have made it clear they wanted changes that lawmakers had so far refused to enact.

Lawmakers who failed to override a veto from Gov. Paul LePage have not put in place regulations for recreational marijuana sales, even though voters approved the use and sale of pot via a referendum in 2016. The Legislature also has put off ranked-choice voting, also approved by voters in 2016. In both instances, their inaction sets the state up for confusion and, likely, lawsuits. Backers of ranked-choice voting are collecting signatures for a people's veto of the law that delays the voting system until 2021 and kills it if it is not brought into compliance with the state constitution.

The Legislature should not take a similar path with expanding Medicaid, which voters resoundingly approved in November. It sounds hackneyed to say this is the most important of the referendum issues lawmakers will deal with this year. But it is true.

By expanding Medicaid, Maine will make insurance coverage available to 80,000 Mainers. These are people who work but can't afford health insurance or their employer doesn't offer it. They are not poor enough or do not have a disability to qualify for Medicaid without an expansion. Under the Affordable Care Act, the federal government covers 90 percent of the cost. Maine is estimated to receive more than $525 million per year for a state investment of about $55 million annually, beginning in 2021, the first full year of implementation.

As Republican strategist Lance Dutson wrote in October: "It is not fiscally conservative to deny hundreds of millions of dollars in federal funding because we will need a 10 percent match. It's fiscally ludicrous."

Plus, there are many humanitarian reasons that should motivate lawmakers to fund the expansion law. With health insurance, 80,000 more Mainers can access preventative care, vaccinations, addiction treatment, counseling and other needed care. Currently, many people without insurance put off doctor's visits until illnesses or injuries become so bad they threaten their work and well-being. When they do seek care, it is more expensive. The cost of that expensive care is borne by hospitals and those with insurance as rates are raised to cover the cost of caring for the uninsured. In fact, a recent analysis found that private insurance premiums were about 7 percent lower in states that had expanded Medicaid compared to those that had not.

Medicaid expansion will also put Maine hospitals on more secure financial footing by reducing their uncompensated care and expanding their patient base. In many rural communities, hospitals are the largest employers.

It will also help the state's economy as billions of federal dollars flow into the state, creating 6,000 new jobs, according to a report by Elizabeth Kilbreth of the Muskie School of Public Service.

Thirty-one states have expanded Medicaid. Governors in these states, many of whom are Republican, would not have expanded Medicaid -- and continued to support expansion -- if it caused state budget crises, tax increases, hospital debt or reduced care for the elderly and disabled, all false claims made by Maine expansion opponents, including LePage.

Here's an assessment from Ohio Gov. John Kasich: "According to a recent assessment of Ohioans who gained coverage through Medicaid expansion, a majority now find it easier to find or keep a job, manage their health to avoid costly trips to the hospital down the road, and even find it easier to put food on the table," he wrote in a Time column.

Maine lawmakers must ignore the grandstanding and demands from LePage, a staunch opponent of expansion. Remember, the Legislature approved expansion five times and each time LePage vetoed it, setting up November's vote. They must also focus on verified budget numbers, not the scary, skewed versions shared by LePage.

Yes, there are other things that also need state funding but legislating is always about prioritizing. Mainers have said extending health insurance to their friends, co-workers and neighbors who don't have it is their priority.

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