While Gov. LePage’s statements that he is open to expanding Medicaid (which is called MaineCare in Maine), have garnered him all sorts of news stories and analysis, one thing has gotten virtually no attention:
His opening proposal is a completely unserious, as there is absolutely no way the federal government could accept it.
What has LePage and his commissioner, Mary Mayhew, proposed?
The governor has asked the federal government to cover ten years worth of all costs plus allow the state to structure the program any way it wishes, via a “global waiver.”
Ten years of full coverage is impossible. The law expanding Medicaid includes three years of full coverage. Thus there is no way under the law for Maine to get ten. And if there was some special Pine Tree State deal cut — and I can’t see how that could be — every other state would sue for ten years of full coverage.
The “global waiver” is also an impossibility. There is no way the federal government can or would allow one state complete discretion when it comes to the rules set down for Medicaid. Some were described in the law and cannot be waived. And, in any case, when a state accepts money from the federal government, it expects to abide by a certain set of regulations. Sure, there is some room for administrative discretion, but the state can’t expect to get all the money — actually, more than any other state — and then set all its own rules.
Given the wholly unserious nature of this opening proposal, what is going on?
One of two things is going on – or perhaps a combination.
First, it’s possible that the proposal is wholly political. Gov. LePage can look like he is willing to bend from his previous position and thus gets positive press and may increase his appeal beyond his electoral base. Given that the initial proposal is wholly unserious, that would be a pretty nifty political trick.
Second, it’s possible that this is just an opening negotiating position. After the federal government turns it down, Gov. LePage might get involved in serious discussions. That could result in some kind of Medicaid expansion in Maine.
As for now, it’s not at all clear if the governor will go beyond this initial, wholly unserious proposal.