There is a major problem with the Medicaid (MaineCare) expansion question on the ballot this November. It’s not just that Medicaid expansion has been tried before in Maine, with less-than-optimal results. Nor is it that the MaineCare program consistently runs in deficit and consumes more and more of the state budget. All of that’s certainly true, and it should give major pause to voters as they consider their vote on expanding it.
However, the major issue with passing this referendum measure and expanding Medicaid as allowed under Obamacare are that there are way too many known unknowns, especially as things stand right now. For one, at a state level, we have no idea who might be governor or have the majority in the Legislature in 2019. As with other complex referendums, like the recent initiative legalizing recreational marijuana, much of the implementation will remain in the hands of the Legislature and governor.
Right now, under the Affordable Care Act, there isn’t much flexibility for states, but that may change. For example, states might be granted waivers to certain requirements of Medicaid expansion. Under the previous administration, only one state was granted these waivers: Indiana, when current Vice President Mike Pence was its governor. However, the Trump administration may well decide to make the waiver process much easier for states, encouraging more to apply. That might lead to more state-level experimentation, both with Medicaid expansion and the implementation of Obamacare as a whole. If the administration moved in that direction, it would be an excellent way for them to add flexibility to Obamacare without repealing the law, but it’s not quite the vision of Medicaid expansion that proponents are touting in Maine.
Just as we don’t know exactly how the next Maine governor and Legislature might implement Medicaid expansion, we also don’t know what kind of budget they might be writing, either. If they feel their hands are tied by a citizen initiative passing Medicaid expansion, it might require major adjustments to the rest of the state budget. We could well end up not having the money to pay for Medicaid expansion, regardless of what level of federal funding is available or how the economy is doing; that’s already been the case in other states. In that situation, Augusta might end up raising taxes (which would displease conservatives) or dramatically cut spending in other areas, like education funding or revenue sharing. It was a sign of a bad trend when the referendum raising taxes to increase education funding was passed, as it marked the beginning of the state budgeting by referendum. We shouldn’t compound the error by passing Medicaid expansion.
We also have no idea how Obamacare might be changed by Congress in the next year, either. If Republicans are able to pass some version of repeal-and-replace, the increased funding now available under the law could be completely eliminated. Then Maine’s hands could well be tied, as the state would be stuck between a referendum guaranteeing Medicaid expansion and a Congress that has eliminated the funding for it. Or Congress might turn the federal funding available under Obamacare into block grants, giving the states a great deal of latitude in how they spend the money. If you’re a moderate supporter of Medicaid expansion, the idea of giving either party in Augusta virtually unchecked control of a huge pile of federal funds ought to be a matter of grave concern.
It’s high time we reject budgeting by referendum. Education and health care account for a vast majority of the state budget, so setting those spending levels through citizen initiative will always end poorly. It could wind up that the Legislature simply ignores the referendum, as they have on education ever since the 55 percent funding requirement was passed. Or, it could be that taking the big decisions out of their hands enables us as voters to continue to elect a highly divided Legislature that remains unwilling to compromise, leading to more citizen initiatives.
We need to return to the days when we trusted our legislators to solve complex policy problems in a productive, bipartisan fashion. If they can’t be trusted to do that, the solution is to send new, better legislators to Augusta, not to constantly work around them through citizen initiatives. So, even if you support Medicaid expansion, don’t vote for this referendum. Instead, let’s elect people who want to work together in a smart, reasonable way to address our problems. That’s how you really fix Augusta.
Jim Fossel, a conservative activist from Gardiner, worked for Sen. Susan Collins. He can be contacted at:
Twitter: @jimfossel
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