PORTLAND, Maine — Tanya Lima used to have health insurance. She’s 23, a full-time student at a local community college, and says, “I’ve been working my way out of poverty since I was born.” Since she’s been old enough to work, she’s had a series of minimum-wage jobs, mostly in food service, and relied on food stamps to make ends meet. Until she recently aged out of the program, her health-care needs were covered by MaineCare, the state’s Medicaid program. She was able to see doctors and get help for her struggles with depression. Right now, though, she says she’s even going without the medication for her asthma.
Lima, like an estimated 70,000 people in Maine alone and hundreds of thousands more around the country, would be eligible for expanded Medicaid under the Affordable Care Act. President Obama’s signature health-care legislation allows those who make up to 138 percent of the federal poverty line, or about $15,800 a year for an individual, to receive state-run, federal-and-state funded insurance. But in response to a lawsuit challenging the constitutionality of the law, the Supreme Court ruled that states could opt out of the federal funds to expand the program, and 23 states, including Maine, have done so.
Gov. Paul LePage, elected in 2010, is now facing not one, but two challengers who argue his five vetoes of bills that would have accepted the federal money to expand MaineCare have hurt Maine residents. The independent candidate, attorney Eliot Cutler, who in 2010 took 36.5 percent of the vote to LePage’s 38.2, is polling in third place this time around, behind LePage and Democratic Rep. Mike Michaud. They remain neck and neck.
LePage argues that people who cannot get Medicaid should buy subsidized “commercial” insurance on the federal exchange. (Maine did not create a state exchange, either.) But while other states were accepting federal money to expand Medicaid, LePage has made cuts in the program, as well as in other services for Maine’s poor. Some 14,500 parents and 10,000 childless adults like Lima were pushed out of the program by the end of last year, according to a Kaiser Health News report. Says Lima, “So much of my life still depends on the government being nice to me.”
Michaud, who voted for the Affordable Care Act in Congress, says he has been surprised that so many governors have refused the Medicaid money. “It’s not a perfect piece of legislation,” he says in an interview with Al Jazeera America. But while LePage and other governors have argued that expanding Medicaid will ultimately cost states money when Washington scales back its contributions to the program after 2017, Michaud disagrees, pointing out that at least one of the five bills LePage vetoed would have only accepted the money for the three years when the state will pay nothing. Says Michaud, “It’s estimated that [expanding Medicaid] will save the state over $600 million over a 10-year time frame, hospitals will get an additional $348 million over that same time frame, job creation is about 3,000 jobs right here in the state and over a 10-year time frame it’s estimated that it will bring in about $3 billion.”
Cutler also believes that accepting the Medicaid money will be a cost-saver for the state. He points out that Maine’s hospitals are struggling again, even after a one-time payment of the state’s MaineCare debt that LePage paid down through bonds backed by the lease of the state’s liquor business. “The next question for the governor, whoever the next governor is, is going to be ‘What are you going to do about this?’ We don’t have another liquor business to sell.”
Maine is just one of six states that could see the governor’s office change hands this November and with it a shift in stance on this key portion of the ACA. In Florida, Republican Gov. Rick Scott, who originally supported the expansion but left it in the hands of a state legislature that killed it, is facing a challenge from former governor Charlie Crist, who has switched parties and declared his support for the ACA. Jason Carter, a grandson of former President Jimmy Carter, stands a good chance of beating incumbent Republican Nathan Deal in Georgia and says he would expand Medicaid. Wisconsin’s governor, Scott Walker, who did expand Medicaid in his state up to 100 percent of the poverty line but refused federal money to do so, is in a close race with Democrat Mary Burke, who has said she’ll take the ACA funds. Kansas, too, could flip to Democrat leadership in November, as conservative Republican Sam Brownback has found himself in an unexpectedly tight race.
Drew Christopher Joy had to cancel the private health insurance he bought on the insurance exchange this year, he says, because his income changed and he no longer made enough money. Yet he still makes too much to qualify for MaineCare: He falls into the gap that could be closed if Maine accepted the federal expansion money. About a week after canceling his private plan, he felt ill and tried to go to an urgent-care center, where he was told he’d have to apply for MaineCare before he could get free care, which is available to those who make up to 150 percent of the poverty rate. As he suspected, he didn’t qualify for MaineCare, and was unable to see a doctor. “There are more barriers now for people to get care,” he says of the current state of affairs in Maine. “It’s not even just that we are left out; it’s actually more difficult.”
Researchers estimate that some 9 million people nationwide will experience “churning” between Medicaid and the exchanges because of changes in their income over the course of a year. Even in states where Medicaid has been fully expanded, there is concern among providers and researchers that this will affect the quality of care people receive. For those like Joy who fall out of the subsidized insurance into a coverage gap with a slight change in income, it presents a much larger problem. Aside from the potentially dangerous consequences of not being able to see a doctor, Joy says, he was told when he spoke to a customer-service representative at the insurance exchange that he might be required to pay back the subsidy he got to buy insurance.
Joy works on the Health Care Is a Human Right campaign at the Southern Maine Workers’ Center, advocating for a single-payer health-care program for the state. Following the example of Vermont, the HCHR campaigners believe it’s possible to go beyond the Affordable Care Act and create a program that would serve everyone in the state. But the election’s focus on the Medicaid expansion, he says, has made it hard to talk about other options. “It feels like everybody is holding their breath, like every conversation is on hold until after the election.”
Cutler says he’d be happy to embrace a state single-payer plan like that in Vermont. “That’s what I proposed for Maine four years ago,” he says of his 2010 run for the governorship.
Michaud, too, says he’d like the opportunity to look at what other states, including Vermont, have done about health care to see if it’s possible to improve on the federal law. “I look forward to really thinking outside the box on how we can do things differently to provide health care for people here.”
Health-care discussions, the HCHR campaigners note, cut across partisan lines and wind up becoming deeply personal. At the Skowhegan State Fair in August, Joy says, they watched a man decked out in “Re-elect LePage” gear walk away with one of their flyers in his back pocket. Cait Vaughan, also of the Southern Maine Workers’ Center, wants to be sure that the conversation around health care is not limited to any one candidate’s platform. “We have to be ready for that conversation whatever happens Nov. 4,” she says.
There is, she continues, a palpable sense of what’s at stake around health care in this election. “At least people are fired up.”
As for Tanya Lima, she’s volunteering her time canvassing voters for Mike Michaud and hoping that a change in the governor’s office will change her situation, too. She has a dream of being a doctor, but for now she’s in a pre-nursing program. “I do want to work in health care,” she says. “I definitely want to help change the system and keep it about the patient and not about their insurance card.”