The supporters of Medicaid expansion celebrated on Election Night as the citizen initiative to take advantage of federal funding under Obamacare to expand the program easily passed statewide.
However, if we were giving out grades for campaigns this year, they wouldn’t receive an “A” simply for winning the election, nor would they get an “F” for successfully passing bad policy via referendum – their grade would be incomplete.
Even if you accepted the idea of Medicaid expansion as being good public policy, the problem with the referendum as it was written was that it offered no payment mechanism for the state’s share of the cost.
Essentially, the referendum asked voters whether they wanted this new program without any explanation of how we’d all end up paying for it – so of course it was approved, just like voters nearly always approve bonds in Maine.
Moreover, there’s already quite a dispute brewing over exactly how much Medicaid expansion will end up costing the state, so we don’t know that end of the formula either. Legislators now face the confusing situation of knowing what the voters want, but not knowing how much it will cost or how to pay for it.
This is the exact opposite of the referendum on education spending from last year, which created a new tax and dedicated it all toward a specific purpose. Even though the new tax was a bad idea, at least that was crafted responsibly, by figuring out how to pay for something before the money was spent.
In the end, the Legislature decided to work around that new tax and find the money to increase education spending another way. The Democrats, despite supposedly being in favor of the tax increase as enacted by the referendum, went along with it because they at least came away with increased education spending in the end.
This session, another battle looms over exactly how to enact Medicaid expansion as the endorsed by the voters. After Democrats showed no willingness to go along with the new tax created to fund education last session, it seems unlikely that they’re going to come up with a new revenue source on their own.
On the flip side, Gov. LePage has ruled out raising taxes or raiding the rainy day fund in order to fund Medicaid expansion. Most Republicans – in the Maine House, anyway; the Senate is, as usual, more of a wild card – will probably support the governor on this. Since the state of Maine, unlike the federal government, has to maintain a balanced budget, following those demands would require that all the funding come from cuts to other programs.
Republicans in both the House and Senate would be wise to stand with the governor and resist any attempt to raise taxes. During the last legislative session, that served them well throughout budget negotiations, as the Legislature eventually found a way to balance the budget without passing new taxes. Sticking to that same strategy this session when it comes to Medicaid expansion is not only good public policy – the state shouldn’t be raising any taxes to fund big government, no matter how well the economy is doing – it’s good politics heading into next year’s elections as well.
With the passage of Medicaid expansion, Democrats probably believe they have the advantage over the Republican Party, but in fact they may well have backed themselves into a corner.
If Augusta Republicans can, for once, stay united and actually work together, they can force Democrats to come up with a plan to pay for Medicaid expansion. After all, Democrats are the ones who have spent the last seven years pushing this policy – they should be the ones who find a way to pay for it.
That means they’ll have to make the cuts elsewhere in the budget, probably digging into the funding for other priorities like K-12 education or municipal revenue sharing. That would force them to backtrack on previous promises in order to fund this latest one, perhaps angering large portions of their base just as they begin to gear up for the midterm elections.
If the Democrats can’t stomach budget cuts, and can’t find support for tax hikes or raiding the rainy day fund, they may well end up delaying Medicaid expansion. That would not only be a clear defeat for them, it could well divide their base and re-energize Republicans.
No matter what happens, both sides should be prepared for a long, bitter fight over this issue that could extend well beyond this year.
Jim Fossel, a conservative activist from Gardiner, worked for Sen. Susan Collins. He can be contacted at:
Twitter: @jimfossel
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