Mainers for Health Care rally outside the State House prior to Gov. Paul LePage's State of the State address, Tuesday, Feb. 13, 2018, in Augusta, Maine. Credit: Robert F. Bukaty | AP

Gov. Paul LePage has finally, as required by federal law, filed a plan to implement Medicaid expansion. The governor, however, asked the federal government to reject Maine’s plan because, he says, it isn’t paid for.

Funding for the initial implementation, which was, by law, supposed to begin in July, is not in the state budget because LePage vetoed a plan to pay for it. He did not offer an alternative funding source.

LePage’s intransigence is preventing thousands of low-income Mainers from accessing health insurance that they are entitled to under state and federal law. Without insurance, many forgo needed medical care, substance abuse treatment and other health services, which can harm their employment and quality of life.

From the first time it was approved by the Legislature, LePage has sought to thwart an expansion of Medicaid as allowed under the Affordable Care Act. After LePage vetoed expansion bills five times, voters last year resoundingly approved an expansion that will extend health insurance to at least 70,000 Mainers, most of whom are working but don’t currently have access to insurance.

Despite this mandate from voters and court orders to begin the implementation process, LePage has continued to fight. His main argument is that the state cannot afford it. This is not true.

Maine ended the fiscal year with a “record” surplus of more than $175 million, the LePage administration bragged in July. Some of that money could be used to cover the cost of the first phase of expansion.

That was the intent of a bill lawmakers approved this summer that would have allocated $3.8 million in state funds to hire new employees to begin the expansion. The funding sources in LD 837, the surplus and state tobacco settlement fund, were not the best solution, but the legislation would have funded expansion for a year, long enough to get it up and running. The state funds would have been matched by $6.4 million in federal funds.

Even in the face of a court order requiring the state to file a plan to implement Medicaid expansion, LePage vetoed the funding measure and House Republicans banded together to sustain the veto in July.

In August, the Maine Supreme Judicial Court reaffirmed that the state was required to file an implementation plan.

Now, LePage has finally submitted the implementation plan that was due in April. But it is not a serious effort to comply with the law. The plan should be rejected, he wrote to the Centers for Medicare and Medicaid Services in an Aug. 31 letter, because it is not paid for.

“I strongly encourage CMS to reject the State Plan Amendment,” LePage wrote.

“ … not one dime of the hundreds of million of dollars that will be needed to pay for the state’s share of the expansion has been appropriated,” he added.

Again, none of the money has been appropriated because he rejected the Legislature funding plan without offering an alternative.

In addition, LePage’s cost projections have long been overinflated. Under the Affordable Care Act, the federal government covers 90 percent of the cost. Maine is estimated to receive more than $525 million per year for a state investment of about $55 million annually, beginning in 2021, the first full year of implementation.

LePage’s refusal to follow the law won’t make its requirements go away. Instead, it needlessly delays access to health care for thousands of deserving Mainers while wasting taxpayer money on legal fees.

No one wins in the scenario.

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