Paul LePage tells lawmakers 'show me the money' on Medicaid expansion

Despite strong support for expansion of Maine’s Medicaid program by voters, Gov. Paul LePage sure doesn’t sound like he has any intention of letting it happen on his watch.

“The money has got to be in the bank before we expand,” LePage said during a swing through Lewiston this week to campaign for a mayoral candidate.

The governor figured that expanding Medicaid to cover about 80,000 more Mainers would cost the state about $60 million in this fiscal year and then $100 million extra each year afterward, estimates significantly higher than the nonpartisan analysis on which the Legislature relies.

The Legislature’s Office of Fiscal and Program Review determined the expansion will bring at least $525 million in federal funds into the state annually. It estimated the state’s share of the yearly cost to be $54 million.

Whatever the number, LePage said in his weekly radio address, those who pushed for expansion of the health care program for low-income Mainers have “absolutely no idea how to pay for it. Once again, they were writing checks they can’t cash.”

The Legislature’s Appropriations and Financial Affairs Committee plans next week to begin its review of the costs associated with the expansion that voters approved by a wide margin.

“It is now the duty of every member of this committee, Democrats and Republicans, to work together to make sure that we understand the cost of expansion and that funds are there when they are needed,” Rep. Drew Gattine, D-Westbrook, said in a written statement.

“Maine people have waited too long for Medicaid expansion and the administration needs to move quickly so that people get the health care they deserve,” he said.

LePage said lawmakers need to determine how they’re going to come up with the money before he can act.

“We have spent seven years restoring fiscal sanity to Augusta, and I will not let them endanger the state’s financial health,” the governor said.

To get the funds, he said, legislators can’t raise taxes, raid the rainy-day fund or fail the thousands of Mainers with physical or intellectual challenges who are on waiting lists for much-needed services.

LePage also said the state has to pay back $60 million to the federal government that Maine owes for the Riverview Psychiatric Center, an issue he said the Legislature has been kicking down the road for five years.

The problem, he said, is that there isn’t enough money.

“It’s a big reach. It’s just not there,” the governor said. “We’re overtaxed already and we just can’t tax anymore.

LePage is no fan of Medicaid expansion anyway — he said he’s worried it will ultimately cause the state to fall behind on hospital and nursing home reimbursements and undermine Maine’s finances the way an earlier bid to offer more Medicaid did 15 years ago.

“These politicians like to talk the talk, now they have to walk the walk. Show me the money,” he said.

Whatever the governor prefers, proponents said he can’t block the expansion.

U.S. Rep. Chellie Pingree, a 1st District Democrat who’s weighing a possible gubernatorial bid in 2018, said in a recent op-ed that LePage doesn’t have the power to veto what nearly 60 percent of voters approved.

“The Maine Constitution says that the Medicaid expansion initiative will take effect 45 days after the Legislature reconvenes in January,” Pingree said. “Within 90 days of taking effect, the initiative requires the state to file a state plan amendment with federal officials. Within 180 days, the state is required to start covering Mainers.”

Backers point out that the law doesn’t say anything about the dates being dependent on whether the governor and lawmakers can agree on how to pay for the change voters endorsed.

Republicans, including LePage, aren’t so sure.

The Maine GOP’s executive director, Jason Savage, said that it’s “time for Democrats and their liberal special-interest group allies to own up to what they have done. How do we pay for your welfare expansion without raising taxes, destroying our state’s credit, or cutting services for those most in need who we all agree must always have our support?”

Democrats, though, hope to avoid getting bogged down in a prolonged battle with the governor about where the money will come from. For them, what’s most important is implementing the expansion that voters called for.

“We will be fully and faithfully implementing this law,” House Speaker Sara Gideon, D-Freeport, said last month. “The Legislature will move swiftly to fund Medicaid expansion as required by law.”

“Any attempts to illegally delay or subvert this law will not be tolerated and will be fought with every recourse at our disposal,” she said.

“Health care is a human right and Medicaid expansion will save lives,” said Sen. Cathy Breen, D-Falmouth. “I look forward to doing the work to make coverage a reality for those Mainers, and will do everything in my power to make sure Gov. LePage and his administration do the same.”

scollins@sunjournal.com