Medicaid expansion is on the ballot again in Maine this November

The next governor could actualize a 2017 referendum and give 70,000 low-income Mainers health care.

Edit by Adam Peck/ ThinkProgress
Edit by Adam Peck/ ThinkProgress

PORTLAND, MAINE — “When I’m in pain, I take Tylenol. I can’t have it looked at,” said 59-year-old Ann Avery, her voice cracking before she started to cry.  

“I did find the list of some of the things that’s wrong me,” she told ThinkProgress. Depression, coronary artery disease, type 2 diabetes, and Piriformis syndrome, to name a few.  

“I have no idea what some of these things are,” Avery said. But she could tell you they’re anxiety-producing. When she inevitably feels pain from any one of the 10 conditions she’s been diagnosed with over the years, she lays down and tries not to think about it. She won’t go to the doctor. She’s uninsured and, as Avery puts it, “they want to be paid… I would too.” 

Avery is a grandmother to a five-year-old girl, a mother of two, and one of at least 70,000 low-income adults in Maine who expected to become eligible for Medicaid coverage over the summer. But she isn’t, thanks to Gov. Paul LePage (R).  


She, along with nearly 59 percent of Mainers, voted to expand Medicaid last November in an unprecedented ballot referendum. LePage ignored the binding vote for months, going as far as saying he “will go to jail before I put the state in red ink” by adding to the state’s Medicaid rolls and expanding insurance eligibility up to 138 percent of poverty level, or $34,638 for a family of four. The governor finally asked the Trump administration to expand Medicaid 10 months after the historic vote, while simultaneously calling on the president to reject it.

The governor’s office also didn’t ask for 9-to-1 federal-state matching funds between July 2 and Sept. 4, a period during which LePage stalled despite a court order. Meanwhile, the lawsuit that pressured LePage into submitting a state plan amendment in September is ongoing and likely won’t end until a supportive governor is in Augusta.

Midterm elections in Maine could put an end to the obstructionism, depending on who is elected to replace LePage.

“Voters have clear choices to make this November between candidates who share their goal of providing affordable, accessible health care options — particularly through Medicaid expansion — and candidates who want to find ways to obstruct and delay, dismantle existing protections, and ignore the law,” said Robyn Merrill, executive director with Maine Equal Justice Partners (MEJP), the advocacy group leading the lawsuit.

Credit: Maine Equal Justice Partners
Credit: Maine Equal Justice Partners

MEJP sued the LePage administration for failing to expand Medicaid by late April on behalf of five Maine residents who were expected to gain insurance once the law went into effect. Avery is among the five plaintiffs.  


This issue is critical to the gubernatorial race, which the Cook Political Report calls a toss up. The latest poll shows Republican Shawn Moody and Democrat Janet Mills neck-and-neck, and that same Suffolk poll found the biggest issue among respondents was health care.

Mills, the state’s current attorney general, declined to represent the LePage administration in the MEJP lawsuit, forcing the state to hire a private lawyer instead. She told The New York Times recently that she’ll implement the measure “on Day 1” should Mainers elect her in November. The two independent candidates running against her also support Medicaid expansion, but her main opponent, entrepreneur Moody, does not. He said during the Republican primary that he would “fight to repeal it,” but added that he would abide by the court’s decision. (The court so far has sided with MEJP.)

During Wednesday’s gubernatorial debate in Portland, Moody struck a more moderate tone, saying Medicaid expansion is settled and law.

But the question becomes, “How do we fund this responsibly?” he added.

Following the debate, ThinkProgress asked Moody whether he’d commit to implementing Medicaid expansion on week one, but he declined to comment. This reporter asked his campaign team to clarify Moody’s new position minutes later, but the two representatives refused to answer, instead walking away when they learned ThinkProgress was asking the question. A reporter with WMTW TV successfully asked Moody about his flip and he replied, “No. Well, I don’t remember that. No, my stance has been pretty consistent.”

Moody’s tone and comments did shift on Wednesday, Mills told ThinkProgress after the debate.

“That appears to be different than what he said during the Republican primary… where he said he would work to repeal Medicaid expansion, where he said health care is not a right but an entitlement, ‘you earn it’,” she said.

“I have no idea what he intends to do — no one does,” Mills added.

Moody, like LePage, said during the debate he’s skeptical of how Maine will fund coverage for thousands more residents. Now, the federal government pays significantly more than the states does, and the legislature did pass a measure in June to appropriate funds for Medicaid expansion well until 2019 by using surplus money and tobacco settlement funds. But LePage vetoed the legislation — his seventh time vetoing anything related to Obamacare’s crowning achievement.


“Funding is not the problem. Political will is the problem,” MEJP’s Merrill told ThinkProgress by email. “I would like to know, what would Shawn Moody have done in that circumstance? Would he have vetoed the law to fund expansion to further delay implementation?… Would he work in earnest and in good faith to get health care to people as soon as possible?”

For now, people like Avery are waiting. She can’t get insurance through an employer, for example, as she’s largely stopped working after a 500-pound bale fell on her right foot while she was working at the paper mill. And regardless, the paper mill closed down in 2015. She has applied for disability benefits, but hasn’t heard back. 

“I don’t do a whole lot,” she said. “I don’t go very far.”

She finds solace by spending time with her granddaughter. Recently, she took her to a Red Sox game, but that was difficult given her host of medical problems. 

“I would love to do different things with her like apple picking or pumpkin picking when I feel good and that doesn’t happen very often,” she said. 

Resentful of LePage, she intends to vote in November.

Medicaid expansion is a ballot initiative in a handful of states, all of which were inspired by Maine. Politicians tried to kill it in Nebraska over the summer, but failed to do so. While Mainers already voted to expand insurance largely for the poor and disabled, health care for thousands still hangs in the balance again in less than a month.