Politics of MaineCare proposals set a trap for Democrats

Three proposals put forward by Gov. Paul LePage to help balance the state budget are illegal. If adopted, they would either be impossible to implement or they would put at risk roughly $1.5 billion in federal funding that currently comes to Maine to fund health care services.

In all three cases, the LePage initiatives would violate what’s called maintenance of effort requirements that are part of the Affordable Care Act.

Federal law says that states can’t cut Medicaid programs (MaineCare in our state) to balance the budget, and to make changes to programs they must receive a waiver from the Centers for Medicare and Medicaid Services. A letter last week from CMS makes it clear that Maine — regardless of the actions of the Legislature or the governor — is unlikely to receive the necessary waivers.

No other state has been granted similar waivers, and the nature of the proposed cuts directly contradict the intent of the Affordable Care Act, which is to expand access health insurance coverage.

There’s no waiver police that would come and throw the governor or members of the Legislature in budget jail. It’s just bad government and bad public policy.

These programs help poor seniors afford their prescription medicine, and provide health insurance through MaineCare to poor families and to poor young adults who are 19 or 20 years old. The elimination of the programs would put prescription drugs out of reach for thousands of seniors and force more people into emergency rooms for their health care.

To adopt these proposals would move Maine in the wrong direction.

But more practically, the elimination of the programs are unlikely to be allowed by the federal government. Even if the Legislature were to pass them, odds are they won’t take effect.

And that’s where pure politics might make the proposals more attractive to both Democrats and Republicans. Some Democrats in the Legislature, who generally oppose reducing access to health care, might be tempted to sign off on the program eliminations, banking that they will never be allowed.

I believe that the experienced Democratic members of the Appropriations Committee would resist, but they have the difficult task of building a budget that can pass through their caucus.

Even though the Democratic caucus might realize that allowing the proposals would create a $37 million gap in the 2013 budget, the tactic might look like a better alternative than other options for bringing the budget into balance.

It’s a dangerous trick, and if Democrats go along they’ll be messing with fire.

For Republicans, the politics of the proposals are much better. They could pass a budget with full knowledge that parts of their plan are invalid, maybe even earning Democratic support for the scheme if it’s part of a larger budget that removes Gov. LePage’s most unreasonable ideas.

Word around the State House is that many Republicans are willing to roll the dice on the waiver request, and Gov. LePage has made it clear that he wants to move forward despite little chance for success.

On paper, the state budget might appear balanced, but we’d all be waiting for the federal shoe to drop. And when it does, the governor and the Republicans in the Legislature — pointing to a bipartisan state budget — could fully blame President Obama and his administration for the hole.

Not only could they attempt to tar the president with a problem solely of their own making, they could also blame him for whatever cuts that they propose to close the gap.

With current Republican State Senate President Kevin Raye challenging U.S. Rep. Mike Michaud and a potentially close presidential election, such a campaign could cause Democrats a significant problem in the 2nd Congressional District, which through redistricting became more conservative last year.

It’s hard to predict in February what issue will have traction in October, but for Democrats there is a real risk that saying yes today could haunt them in the fall.

Democrats and Republicans in the Legislature appear to be working toward a bipartisan solution to close a large budget hole. But as they get closer to any deal, the dollars will be harder to come by and the temptation to gamble will become greater.

For Republicans, it might look like a good bet. The politics line up in their favor regardless of the outcome of the waiver request.

For Democrats, the odds are long, and the best case scenario is that they would have to return to Augusta and help Republicans close a bipartisan budget hole.

David Farmer is a political and media consultant. He was formerly deputy chief of staff and communications director for Gov. John E. Baldacci and a longtime journalist. His clients include Maine Equal Justice Partners and EngageMaine. You can reach him at dfarmer14@hotmail.com. Follow him on Twitter @dfarmer14.