Frary: Maine's Medicaid Expansion Follies

John Frary
Prof. John Frary

Mark Giangreco, my new friend at the Democratic Governor’s Association (DGA), just sent an e-mail urging me “to join Mike Michaud and the DGA to tell Governor LePage to support Medicaid expansion TODAY!” Mark tells me our governor has it in his power to “give health care to thousands of people in need.”

The DGA’s message fluctuates between pathos and indignation: “If you think the weather has been cold this week, it’s nothing compared to the thousands of uninsured who have been left out in the cold by Tea Party governors. Maine’s Paul LePage is refusing to allow federal Medicaid dollars to cover 70,000 Mainers—even though it would ultimately save the state money—all because the Medicaid expansion was part of President Obama’s Affordable Care Act.” Mark just doesn’t think it’s right for our governor to “put politics before the middle class.”

Mark pushes most of the usual DGA buttons: pathos (thousands of Mainers left out in the cold); the Tea Party as primary source of our national problems—an evil influence so ubiquitous that its shadow looms even over the nation’s babes in their very cribs; a tender love for the middle class; and a furious loathing for politics. If you think you hate politics, you have no idea what hate is. Those folks at the Democratic Governors’ Association can hardly sleep from their fury at the loathsome works of those vile politicians.

The only omission from the usual script are denunciations of the Koch Brothers and sentimental hand-wringing over our beleaguered “working families.”

The DGA expects us to believe that our governor is motivated solely by hatred for the poor, the middle class, the State of Maine, and Barack Obama. In reality his motivation is just a tad more complicated. He’s also concerned about the financing of the benefits he’s being asked to confer upon the multitude. He’s acutely aware that the money the Democrats demand he shower on the multitude is not his to confer. It must be taken from the taxpayers. More, he’s convinced that the federal government will inevitably stick the state with an increasing proportion of the Medicaid expansion’s cost; costs which he believes will put the state hopelessly in hock.

Maine’s Democrats appear to have no doubts about the federal government’s commitment to carry most of the burden for Medicaid expansion, now and forever after. Paul LePage remembers “If you like your insurance plan, you can keep your insurance plan” and grows skeptical.

It may be helpful to take a short trip down memory lane. On November 7 of last year, Senator Alan Simpson told his listeners in Orono that “…when you hear that wonderful phrase from your elected official standing there in the beauty of the glare of the camera: ‘I know what the problem is and we can get it done without touching precious Medicare, precious Medicaid, precious Defense, or precious Social Security. Then, you should get up and say, you, sir, are making a terminological inexactitude, you lying son of a bitch.”

If we take Senators Simpson and Bill Cohen, his colloquium partner seriously, then we must hesitate to take assurances that Maine can always count on the feds to keep up their end of the Medicaid expansion payment. Even without the expansion, our state’s ability to pay for its MaineCare in full is questionable.

It’s not entirely unreasonable to set aside all the benefits we can expect from Medicaid expansion and think about its financing. As it happens, I’m in a position to offer some help. Within a day of hearing from Mr. Giangreco, I received e-mail messages from both Mrs. Ngozi Okonjo-Iweala, Nigeria’s Minister of Finance, and Mr. Tony Oby of the Central Bank of Nigeria offering opportunities to pick up millions with very little effort. I immediately sent these contacts along to the House Speaker Mark Eves (D-North Berwick) and Senate President Justin Alfond (D-Portland).

The kind of money my West African benefactors are offering will not cover the state’s end of the Medicaid expansion, but no one can fairly say that the Democrats have addressed the financing problem better than John Frary, or even as well.

Word reaches me that four or five Republican senators may side with the Democrats to override Governor LePage’s veto. If my informants are accurate there are two rationales supporting their defection from the GOP caucus. First, they anticipate large savings from preventive medicine, i.e., they reason that folks will go looking for ways to prolong their lives once they are relieved of paying. Second, they reason that if the Feds renege Maine can simple reverse the Medicaid expansion.

Over seventy years ago Sir William Beveridge, the author of the British universal single-payer health service plan, also argued that “free” medical care would be a long run cost saver because of preventive medical services. In reality the costs have gone steadily, steadily upwards ever since. I doubt these GOP senators have heard of the Beveridge Plan, much less inquired into the reasons his optimistic expectation proved false. Sir William’s hopes and dreams may be ancient history but The Maine Wire has more recent data in the article “Misleading Arguments for Medicaid Expansion.” I quote the passage that introduces the data: “Maine submitted a waiver to the federal government in 2002 to expand Medicaid eligibility to childless adults. This first expansion was passed with many of the same goals associated with the current expansion proposal: cover the uninsured and reduce charity care. New Hampshire, at the same time, decided against expansion. Comparing the experiences of the two states provides a highly relevant lesson for today’s policymakers.”

[Recommended: Misleading Arguments for Medicaid Expansion…]

If there is a counter to this article’s analysis we need to hear it from these senators, if only to reassure us that they are paying attention. As for abruptly cutting 70,000 people off from a government benefit; when has anything like that ever happened?

Now, let’s set aside policy questions and consider the political realities. There will be benefits and beneficiaries of the expansion, especially hospitals in certain senatorial districts. The question of who is actually paying, however, will be cloudy and hard to pin down. Above all, the legislators who vote for the expansion are in no danger of being held responsible even if our governor’s most dire budgetary and economic fears are realized. Few people will connect them with the consequences of their votes.

Professor John Frary of Farmington, Maine is a former US Congress candidate and retired history professor, a Board Member of Maine Taxpayers United and publisher of and can be reached


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