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Maine Should Now Move Quickly to Implement Medicaid Expansion

Now that Maine voters overwhelmingly approved a ballot initiative to adopt the Affordable Care Act’s (ACA) Medicaid expansion and provide health coverage to about 70,000 low-income Mainers, Gov. Paul LePage and lawmakers should move quickly to implement the new law.

With yesterday’s vote, by a 59 to 41 percent margin, Maine is poised to benefit from the Medicaid expansion in the same far-reaching ways as other states. Here’s what the expansion will mean for the state:

  • Health coverage gains. While all states have seen gains in health coverage since the ACA’s major coverage expansions took effect, the gains have been greatest in states that expanded Medicaid. These gains have translated into improvements in residents’ access to care, health, and financial security.
  • Support for low-income workers. Most of the uninsured Mainers who stand to gain Medicaid coverage are workers.  Most of them work in restaurants, construction, grocery stores, and other jobs that often don’t offer health coverage to their employees.


    The Medicaid expansion will also help low-income Mainers find and keep jobs. In Ohio, 75 percent of expansion enrollees who were unemployed and looking for a job when they gained coverage said that having Medicaid made that task easier. And in Michigan, 55 percent of expansion enrollees who were unemployed when they gained coverage said that it made them better able to look for a job, and 69 percent of enrollees who were working said they did better at their jobs once they had coverage.

  • Help for rural Maine. The uninsured rate among low-income residents is nearly twice as high in rural Maine as in the state’s urban areas, so rural Mainers will likely benefit disproportionately from the coverage gains under the expansion. And the lower costs for uncompensated care that Maine’s rural hospitals will face, and the higher revenues they will collect due to increased Medicaid payments, should boost those hospitals — which, like rural hospitals nationwide, have been under severe financial stress.

While Gov. LePage continues to oppose the expansion, it’s now state law and must be implemented. Under Maine’s constitution, a voter-approved initiative that requires the state to spend money doesn’t become operable until 45 days after the legislature next convenes (which will happen on January 3, 2018). After that, the LePage Administration has 90 days to submit a state plan amendment to the federal government to implement the expansion.

During this time, lawmakers will need to decide how to fund the expansion. With the federal government paying 95 percent of expansion costs this year, 94 percent next year, and no less than 90 percent in 2020 and the years thereafter, the state’s cost should be modest. (Gov. LePage has vastly overstated Maine’s likely expansion costs, as we’ve shown.)

All this means that Mainers likely won’t get coverage through the expansion until the second half of 2018.

Yesterday’s vote is further evidence that, despite repeated attempts by President Trump and congressional Republicans to repeal the ACA, the public supports the law — including the Medicaid expansion. More than 80 percent of Americans support continued federal funding for expansion, survey data show.

Across the country, more than 4.5 million uninsured people would gain Medicaid eligibility if the remaining 18 states that haven’t adopted the Medicaid expansion did so. Yesterday’s vote should encourage policymakers in these states to do right by their constituents and take another look at expansion during next year’s legislative sessions. It also should boost efforts already underway to pursue similar ballot initiatives in states like Utah, Missouri, and Idaho.