June 3, 2013; Bangor Daily News

If it isn’t hard enough already to monitor which states will and won’t expand Medicaid coverage and why, check out the situation in Maine. Governor Paul LePage announced that he won’t even discuss Medicaid expansion, which passed the Maine House by a 89-51 vote, though short of the two-thirds majority needed to override a potential veto. Fifty thousand people in Maine would gain coverage if the state were to expand its Medicaid program.

LePage’s reasoning, however, differs from the typical troglodyte responses of many Republican governors who have rejected this federally subsidized option of the Affordable Care Act. He said Medicaid expansion is a no-go until the state appropriates money to help a waiting list of 3,100 people with developmental disabilities access services, such as housing and other programs. According to LePage, “The Legislature has ignored the needs of these citizens for years, but now the Democrats want to expand welfare to able-bodied adults with no children.” Democrats, led by state representative Linda Sanborn, called LePage’s argument a distraction from what’s really important. The sponsor of the Medicaid expansion bill, Sanborn said, “If we do not accept the federal funds, we will still have 3,100 on the wait list.”

LePage vetoed the first version of this effort, a bill that would have expanded Medicaid and appropriated funds for the state to pay 39 hospitals the $484 million that they are owed for unpaid Medicaid bills. The new Medicaid expansion bill, which LePage is also threatening to veto, does not include the hospital payback provision.

Despite LePage’s feint toward helping the developmentally disabled, his own proposed state budget would provide assistance to only 85 of the 3,100 people on the waiting list for help with accessing services. In fact, with the Affordable Care Act and expanded Medicaid, the disabled will get more automatic access to healthcare and other services than they do through the sometimes-Kafkaesque programmatic hurdles they face when accessing help through existing programs. Somehow, LePage’s strategy of holding Medicaid expansion hostage to the needs of the developmentally disabled doesn’t seem compelling enough to warrant turning down affordable healthcare coverage for 50,000 state residents—and no, purchasing subsidized private insurance on a health exchange, given the costs and co-pays of private insurance, is not the same as expanded Medicaid.—Rick Cohen