Let’s start with the good news. Yesterday, voters in Maine overwhelmingly approved the expansion of Medicaid in their state (59% to 41%), bucking the will of Republican Governor Paul LePage. The Governor had vetoed Medicaid expansion five times, but the people had the final say in yesterday’s referendum. Now, some 70,000 Mainers should be newly eligible for Medicaid. That includes thousands of older residents not yet eligible for Medicare who can’t afford private health coverage. Forbes calls the outcome a “victory for Obamacare.”
A spokesman for the group that sponsored the ballot initiative starkly defined the stakes.
“Too many Mainers have already waited too long for health care. They shouldn’t have to wait any longer. The governor cannot ignore the law or the Constitution of Maine. Simply put, the governor does not have veto power of citizen’s initiatives and he cannot ignore the law.” – David Farmer, Maine Medicaid expansion advocate
The federal government will cover 90% of the cost of expansion, injecting nearly $500 million into Maine’s economy in the next two fiscal years. A recent study says those federal funds will generate 6,000 new jobs (mostly in the health sector).
Maine becomes the 33rd state (including D.C.) to expand Medicare. But as Sarah Kliff writes in Vox, the way Maine did it provides a potential template for expanding the program in other states:
Maine is the first state to expand Medicaid during the Trump administration, and also the first to do so via a ballot initiative than legislation. This offers a possible playbook for health care advocates in other states looking to extend coverage but stymied by political opposition. – Sarah Kliff, Vox 11/7/17
Of the 17 holdout states, Utah, Idaho, and Kansas may see Medicaid expansion on the ballot in 2018. Increased coverage, better access to care, and a huge economic boon should make this an obvious ‘yes’ vote – though outcomes are not guaranteed, especially without robust advocacy.
Advocates can expect the same kind of pushback from conservatives in these other states. Governor LaPage peddled the falsehood that the expansion would put an unsustainable financial burden on the Maine government. The Portland-Press Herald reports that the governor also perpetuated the myth that expanding Medicaid would give “free” healthcare to “able-bodied adults who can work and contribute to their own health insurance costs.”
And that leads us to some bad news, which is that the Trump administration is using that same canard to chip away at Medicaid in red states across the country. Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), announced a rule change this week that will allow states to impose work requirements on Medicaid beneficiaries. This supposes, of course, that there are legions of lazy Medicaid enrollees who could work, but just don’t want to – a total myth.
As Talking Points Memo reported, most adults on Medicaid suffer from some of disability and cannot work. According to a 2017 study by the Kaiser Family Foundation, only 27% of Medicaid beneficiaries are adults without disabilities. Of those, 60% are, in fact, working. Most of the recipients not working have one of the following extenuating circumstances:
Caring for a family member full-time
Lack of jobs in their area
Criminal record prevents employment
The bottom line: most of the Medicaid recipients who can work do work
These new conditions will especially onerous for some six million older Americans (age 45-64) currently on Medicaid. This age group experiences more disability and chronic illness than younger recipients do. If forced to go without care because of new restrictions, they will arrive at the doorstep of Medicare in worse health, which can drive up program costs.
The Obama administration had it right, by allowing rule changes at the state level which “increase and strengthen overall coverage of low-income individuals” and “improve health outcomes for Medicaid and other low-income populations.” The Trump administration, under Verma’s leadership, is showing its contempt for the elderly and poor – and knee-jerk suspicion of federal programs that actually help society’s most vulnerable. What’s more, CMS’ new rules defy candidate Trump’s promises to “not touch your Medicaid.” But as we’ve seen with his pledges to protect Social Security and Medicare, the President’s promises are not worth the megabits they’re tweeted on.