PORTLAND,
Me. — Night after night, in the sharp autumn air, canvassers are
knocking on doors across Maine in hopes of getting tens of thousands of
poor adults insured through Medicaid. Gov. Paul LePage, a Republican,
has five times vetoed expanding access to the program under the
Affordable Care Act. Next month, voters here will be the first in the
nation to decide the issue by referendum.
But
even in this liberal city, canvassers have encountered resistance from
some as they stood on creaky porches and leaf-strewn steps to argue, as
Lily SanGiovanni did the other night, that “health care is a human
right.”
“My
only question is where is the money coming from?” asked Michael Bunker,
35, a gym owner who spent 10 minutes debating the issue on his doorstep
with Ms. SanGiovanni, a volunteer with Mainers for Health Care,
the lead pro-expansion group. “I agree everyone should have free health
care, it sounds great. But I can’t sign anything that’s just going to
add to the federal debt.”
The
referendum on Nov. 7 represents a new front in the pitched political
battles over health care. Maine is one of 19 states whose Republican
governors or legislatures have refused to expand Medicaid under
Obamacare, and the other holdouts — particularly Utah and Idaho, where
newly formed committees are working to get a Medicaid expansion question
on next year’s ballot — are closely watching the initiative, whose
outcome may offer clues about the salience of the issue in next year’s
midterm congressional elections.
After
President Trump and Republicans in Congress spent much of the year
trying to repeal the health law and cut spending on Medicaid, a
half-century old entitlement program that covers one in five Americans,
the pro-expansion side in Maine is hoping to benefit from energized
public support for it.
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Turnout
may be the biggest challenge for the advocacy groups leading the
effort. There are no national or statewide races here to drive people to
the polls this year. And Mr. LePage’s stance on government safety net
programs appeals to many voters in the state’s more rural regions. He
derides Medicaid expansion as “pure welfare” that would burden the
state’s taxpayers.
Senator
Susan Collins of Maine, one of the few Republicans who firmly opposed
the Obamacare repeal bills, is not taking a position on the ballot
measure — she never does on referendums, according to her staff. But
leaders of the campaign are hoping her outspoken support for Medicaid
during the repeal battles will help.
About
80,000 additional Mainers would become eligible for the program if the
ballot measure were to succeed, according to the nonpartisan Maine Office of Program and Fiscal Review,
although those with income above the poverty line currently qualify for
subsidized coverage through the Obamacare marketplace. In all, more
than 2.5 million poor uninsured adults across the country would gain
access to Medicaid if the holdout states expanded the program, joining
about 11 million who have already signed up under the law.
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Kari
Medeiros, 40, of Eastport, a tiny town in the state’s poorest county,
earns less than $5,000 a year cleaning houses and pet sitting, and has
back pain that has worsened to the point where she can barely mop and
sweep.
“With
MaineCare I believe I’d be able to find a provider who would see me,”
she said, referring to the state’s Medicaid program. “But a lot of
people here don’t vote. So many families here are having addiction
problems with their loved ones, and they’re not focused on going to vote
— even though those are the people that need it the most.”
Under
the Affordable Care Act, the federal government picked up the entire
cost of new enrollees under Medicaid expansion for the first three years
and will continue to pay at least 90 percent. (States cover a
significantly larger portion of the expenses of the regular Medicaid
program.) The law allows any citizen with income up to 138 percent of
the poverty level — $16,642 for an individual, $24,600 for a family of
four — to qualify.
The
main arguments for expanding the program here are that it would help
financially fragile rural hospitals, create jobs and provide care for
vulnerable people who have long gone without it.
But
Mr. LePage and other opponents say that Maine should know better. The
state undertook a more modest expansion of Medicaid in 2002, under
former Gov. John Baldacci, a Democrat. Afterward, Maine struggled with
budget shortfalls and fell behind on Medicaid payments to hospitals.
“People
don’t want to acknowledge the unintended consequences that Maine has
already experienced,” said Brent Littlefield, a political adviser to Mr.
LePage who is serving as the spokesman for Welfare to Work,
the committee leading the opposition. He said that even with the
federal government paying most of the cost — a situation that could
change if Congress eventually succeeds in repealing Obamacare — the
state could owe close to $100 million a year, according to estimates
from the LePage administration.
The
Office of Program and Fiscal Review has estimated a lower state cost,
about $54 million a year once the federal share drops to 90 percent in
2021. Maine would not receive the full 90 percent match for parents of
young children because many already qualify for the program.
Maine’s
legislature, which is controlled by Democrats in the House and
Republicans, by one vote, in the Senate, could move to block the
referendum if it were to pass, but since it voted for Medicaid expansion
five times already, supporters and opponents alike believe it is
unlikely to meddle. And the governor would have no authority to veto the
outcome. The only other threat would be if Congress succeeded in
repealing the Affordable Care Act and ended the Medicaid expansion
program.
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Supporters
of the measure have knocked on 150,000 doors since July and have run
four television ads statewide. Mainers for Health Care had raised about
$480,000 as of early October, including $375,000 from the Fairness
Project, a left-leaning group founded in California. It is putting out
national appeals for donations, including through Organizing for Action,
the political group that grew out of former President Barack Obama’s
campaigns.
Welfare
to Work had raised $192,500, with its contributions coming from a
handful of frequent Republican donors in the state. Mr. Littlefield
would not discuss the opposition’s strategies but the group has at least
two ads running on television statewide and Mr. LePage has been blasting the initiative on talk radio and in other public comments.
Canvassers
for the measure have found one of the biggest obstacles is lack of
knowledge about the issue, even among those who would benefit. Nicole
Simard, 33, interrupted Ms. SanGiovanni a few seconds into her pitch,
saying, “I agree, I agree. I have friends that are suffering right now,
that don’t have insurance. My sister is one.” Like many people Ms.
SanGiovanni encountered that night, Ms. Simard said she had not been
aware of the referendum but that she would vote for it.
“Absolutely, 100 percent,” she promised.
The
following night in Bangor, about two hours north, canvassers
encountered Robert Schmidt, a veteran who said he was conflicted about
free coverage for low-income people regardless of whether they worked.
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“I
had to sign my life away to get my free care,” he said of the
government coverage he receives as a veteran. “I can’t do handouts. On
the other hand, with all the money we spend across the world, why aren’t
we taking care of our own people?”
Mr. Schmidt, who is 53 and works at a big-box store, said he was not sure how he would vote.
A
few houses down, his neighbors, Kirsten Reed and James Smith, told the
canvassers that they would eagerly vote for Medicaid expansion now that
they had been reminded about it. Both uninsured, Mr. Smith, a carpenter,
and Ms. Reed, an artist and writer, said they had seen a pro-expansion
ad on television but had forgotten about it.
“I
could have easily been someone who believes in this but didn’t get out
and vote,” Ms. Reed, 44, told the canvassers, Cokie Giles and Cynthia
Martinez, both nurses.
State
Representative Heather Sirocki, a Republican active in fighting the
ballot measure, said the uninsured could always sign up for charity care
at hospitals, which are obligated to provide it to people under a
certain income level.
At the Oasis Free Clinic
in Brunswick, which sees about 450 uninsured patients a year, R.J.
Miller, 33, who suffers from psoriatic arthritis that causes severe
joint pain and swelling, said he worried about relying indefinitely on
free care to control his condition.
“I’ve
lived in other countries where nobody’s going to let you fall all the
way down,” said Mr. Miller, a jazz drummer. “We buy into the American
legend of, ‘You can take care of yourself anywhere, kid.’ That’s a bad
lesson to teach everybody.”
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