LePage and other Medicaid expansion foes attacked the “alternative” they say they back

Opponents of Medicaid expansion took strong steps and made strong statements against an “alternative” they now say they back. This makes their stated support for this “alternative” look like political rhetoric.

Now, Medicaid expansion is supported by most Maine legislators and most Maine people. But that shouldn’t be surprising. Heck, even in New Hampshire, a state with a reputation for fiscal conservatism, it’s backed two-to-one.

Credit: 401(K)2013/Creative Commons.

Credit: 401(K)2013/Creative Commons.

In trying to prevent it being passed by a veto-proof majority, opponents of Medicaid expansion in Maine have made all sorts of arguments, including relying on a deeply flawed and discredited report by the Alexander Group.

They’ve also claimed there is an alternative available, to let some people buy subsidized insurance through the insurance marketplace. As I’ve explained, this would leave the poorest and neediest out altogether. Under the law, Mainers with an income under the poverty level do not qualify for subsidies and a state can’t cover them with Medicaid while sending others eligible under expansion to the insurance marketplace (also known as the insurance exchange). (A full explanation of how this works in Maine is available from the Kaiser Family Foundation.) But this is not acknowledged by expansion opponents.

And in the past, these same politicians attacked the insurance marketplaces

Let us count the ways:

1. Backing a bill that would put state and federal officials in jail for putting into effect any part of the Affordable Care Act

Proposed in 2011 by several Republican legislators, the official summary of LD1233 says:

This bill prohibits a federal or state official, agent or employee from enforcing the federal Patient Protection and Affordable Care Act, or any other statute, law, rule, regulation or order made in connection with that Act. Violation by a federal official is a Class C crime, punishable by up to 5 years in prison and a fine of up to $5,000. Violation by a state official is a Class D crime, punishable by less than one year in jail and a fine of up to $2,000. The bill also allows a civil cause of action.

Rep. Deborah Sanderson, who recently touted the marketplace as an alternative to Medicaid expansion, voted for LD1233. Obviously, the marketplace is one part of the the Affordable Care Act. Jailing or fining officials involved in implementing it doesn’t exactly scream support for the marketplace.

2. Saying that the involvement of the IRS with Obamacare makes the agency “the new Gestapo”

Remember this? In one of his Saturday radio addresses in July 2012, Gov. LePage said, “You must buy health insurance or pay the new Gestapo – the I.R.S.”

Putting aside the fact that only about 7% of Americans are expected to pay anything for not buying insurance, keep in mind that the main role of the IRS in the ACA is implementing the subsidies received by at least four out of five people buying insurance through the marketplace.

Thus, if you support the system of people buying subsidized insurance through the exchange, it makes no sense to go after the agency that’s making sure people receive those subsidies.

3. Opposing Maine setting up its own insurance marketplace and railing against it as anti-freedom

Before Gov. LePage was elected, Maine had put time into planning for an insurance marketplace, the mechanism today’s Medicaid opponents say they support. Maine had received federal grants to develop a state-run marketplace.

Republicans in the Maine Legislature, then the majority, put this endeavor on hold. Then, in April 2012, “LePage returned a $5.8 million federal grant that would have helped Maine pay for setting up an exchange.” And in November 2012, the governor said Maine would not set up an exchange.

“I’m not lifting a finger,” he said in an interview with Bloomberg at a Republican Governors Association meeting in Las Vegas. “We’re not going to get involved.” [source]

Now, that doesn’t sound like someone who thinks buying subsidized insurance through the marketplace is a good idea.

But LePage was not alone in his disdain for the insurance marketplace as public policy.

Here’s an editorial from the conservative Maine Wire, noting that Republican legislators opposed a state exchange, and defining this way of buying insurance in highly negative terms:

The Legislature’s Insurance and Financial Services Committee on Thursday cast a critical vote to protect the people of Maine from the gathering storm of the federal Affordable Care Act, also known as Obamacare. . .

Obamacare propagandists harnessed the term “exchange” to conjure up images of a robust marketplace where insurers and insured can find each other and dance away into a fully insured wonderland. In reality, exchanges as implemented by Obamacare inject more government control and prevent actual market forces from putting downward pressure on insurance rates. In effect, the Obamacare exchanges amount to a wholesale replacement of the private health insurance market, run by bureaucrats, and created to ensure the ability of the federal government to do what it is constitutionally prevented from doing – force every American to purchase an insurance policy.

4. Not promoting the insurance exchange to Maine people

Gov. LePage has done nothing to promote the marketplace to Maine people. He and other expansion opponents don’t mention it much, and only do so when presenting them as an alternative to Medicaid expansion.

As LePage promised, he hasn’t lifted a finger to encourage Mainers to check options, prices and subsidies, and sign up for a plan. And, as far as I can see, neither have other opponents of expansion.

Research by the Kaiser Family Foundation has found that the uninsured don’t know much about the Affordable Care Act. Many don’t know that they would need to sign up by the end of March 2014 to be able to choose subsidized insurance through the exchange this year. Medicaid expansion opponents say they think low-income Mainers should get coverage that way but haven’t explained how the system works nor told people about this deadline.

If these individuals really viewed the insurance marketplace as viable and positive public policy, then why are they so silent?

That silence — and the rest of what Medicaid expansion opponents have done and said — speaks volumes.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.