When it comes to Medicaid expansion, at one time, Maine was ahead of the curve. In 2002, long before the Affordable Care Act (Obamacare) was established, Maine elected to expand Medicaid availability to able-bodied, childless adults at or below 125 percent of the federal poverty line.
The result was an incredibly costly program that cannibalized other important state programs, such as education, as enrollment greatly exceeded all projections. It was ineffective at achieving its stated goals and left Maine hospitals footing the bill for hundreds of millions of dollars for services that taxpayers couldn’t afford to pay within a reasonable amount of time.
In addition to putting our hospitals at risk, it put our most vulnerable at risk. While the elderly and our most severely disabled citizens languished on long wait lists for essential services, able-bodied adults working only part time (the cutoff is $16,000 for a single adult, which is less than full time at the current $9 minimum wage) received free care under MaineCare.
Legislators decided to cut their losses after nine long years of this failed experiment, voting to roll the unsustainable expansion back in 2011 and again in 2012.
Around the same time, Washington decided that Medicaid expansion was a great idea and began to incentivize states to expand their Medicaid programs (these expansions were originally meant to be mandatory until the courts stepped in) under Obamacare, otherwise known as the Affordable Care Act.
Many states opted to take the incentives to expand their Medicaid welfare programs, but we have seen this fail before, and up until this point, we have been unwilling to saddle our taxpayers with this burden once more.
So here we are, a little more than one year from the last failed attempt to expand Medicaid under Obamacare, and the question is before us, yet again.
But this time, it won’t be up to the Legislature to decide. This November, Question 2 will present voters with the question, “Do you want Maine to expand Medicaid to provide health care coverage for qualified adults under age 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 means $16,643 for a single person and $22,412 for a family of two?”
It is important to note that noncitizens under the age of 21 would also qualify for Medicaid under this referendum question.
While the cost of this expansion would be shared between the federal government and our state government, the Legislature’s Office of Fiscal and Program Review estimates this welfare expansion will cost Maine taxpayers an additional $54,495,000 annually.
But history has proven that the cost will be significant and unpredictable.
Proponents estimated that only 11,000 new people would enroll when we expanded in 2002, yet within 14 months, enrollment hit 17,000. The real kicker is that many of these new enrollees had carried private insurance before they switched over to Medicaid to receive care on the taxpayer’s dime. This phenomenon is referred to as “crowding out” and because of it, the uninsured rate stayed relatively the same in spite of the costly expansion.
Other states that have expanded under Obamacare have experienced similar results. Within a year and a half, California’s Medicaid expansion ran 222 percent over budget, putting it $14.7 billion in the red. Oregon’s ran 128 percent over budget, putting it $2 billion in the red. North Dakota’s ran 114 percent over budget, putting it $67 million in the red. West Virginia, a state very similar to Maine, ran 46 percent over budget in the first year alone, costing it an additional $198 million.
Until we vote in November, you will hear a number of compelling arguments on both sides. But one only needs to look to history to understand that Medicaid expansion isn’t the answer we are looking for. It will significantly increase our reliance on the federal government and cut deeply into resources that are meant for the neediest of citizens — all with no real gain.