GOP loses policy argument on Medicaid expansion, focuses instead on process

Right now, Maine’s hospitals and Republicans in the Legislature have hitched their rhetorical wagon to a process argument.

Democrats are moving forward with a plan to pass legislation that includes a massive payout to Maine’s hospitals coupled with a plan, paid for by the federal government, to expand access to health care to 69,500 uninsured Mainers, many of whom work but aren’t paid enough to buy health insurance on their own.

Maine’s hospitals obviously want their money, and there’s bipartisan agreement that they should get it. They also say that they support expanding health care, which would help reduce their costs and also help to resolve structural problems from reduced caseloads and patient visits.

But the Maine Hospital Association has made its deal with Gov. Paul LePage, and it will not cross him. The association has threatened war with Democrats if it doesn’t get its way. Of course, if you ask me, war was declared sometime ago, and it will continue regardless of what happens in the next few weeks.

LePage and some Republicans haven’t been clear on whether or not they support expanding health care.

Despite the fact that it’s 100 percent federally funded, would save the state $690 million in the next 10 years and change lives for the better, some Republicans – not all, mind you – have tried to hedge their position.

They don’t want to outright oppose expanding health care because it is wildly popular among voters. Statewide polls show nearly 70 percent support for expansion among Maine voters.

And the benefits of the expansion tend to skew toward rural communities where Republicans have their base of support.

But they also ideologically aren’t sure that they can support it, despite growing acceptance from other conservatives around the country.

So they’re all in the bind, and they’re making excuses.

Maine’s hospitals are in a position to make out like kings: big cash payment today, continued payments for providing health care to more people tomorrow and into the future.

But they’re stuck. They’re worried that the governor won’t go along with a bill that combines the two issues and that he might veto the whole thing.

Republicans are completely torqued up because combining the two issues forces them into an uncomfortable position. If they vote against the combined bill, they vote against one of their top political priorities: paying the hospitals.

If they vote for the bill, then they may be running counter to their tea party governor who says he hates the Affordable Care Act. Yet, somehow with a straight face, he says that he’s still considering one of its key elements, the expansion of health care.

What to do? What to do?

Democrats have demonstrated that they can think and act strategically around this issue. If they go through with their plans, they are going to force Republicans to choose whether or not they are willing to compromise to get what they want.

LePage and his allies have spent tens of thousands of dollars to promote paying the hospitals while ignoring almost every other substantial issue so far this year, including a budget left in shambles by an unserious gubernatorial proposal.

They’ve decided the issue is a political winner.

Democrats, who also support paying the hospitals, have decided to go along with the governor’s hospital plan despite the fact they have doubts about some of the payment mechanisms, including the scheme to promise future state revenues to borrow money for a current obligation.

The reason is simple: Democrats support paying the hospitals, and they want a deal with the governor to move the state forward.

But they also have priorities of their own, and one of those is reducing the number of people without access to health care and also reforming health care to reduce costs in the future.

With divided government, neither the Legislature nor the executive branch can make law without the other. If you want to get things done, you have two choices: You can try to bull things through like the governor is doing, or you can find a compromise.

Democrats have given the governor an opportunity to win on the issue he’s made his top priority. They’ve given the hospitals a clear path to settling an old debt. And they’ve crafted a plan that would make sure thousands of working Mainers have access to health care.

And in so doing, they’ve left Republicans to argue about process. Because they’ve lost – and lost big – on the policy.

David Farmer

About David Farmer

David Farmer is a political and media consultant in Portland, where he lives with his wife and two children. He was senior adviser to Democrat Mike Michaud’s campaign for governor and a longtime journalist. You can reach him at