Outsmarting Republican budget games on Medicaid expansion

Earlier this week, the Legislature released a preliminary list of bills.

There are the normal ones, looking to change the tax code in one way or another, several around energy – including a proposal for a Maine version of The Green New Deal – Republican proposals to undermine the state’s referenda process and a bill to codify the protections of the Affordable Care Act in Maine law.

But the biggest bill – the one that will dominate the attention of the Legislature and Gov. Janet Mills – is the two-year state budget, which is due next month.

The budget sets the spending priorities for the state. It also includes major policy initiatives.

Mills, fulfilling a campaign promise – and the will of the voters – took action to expand Medicaid on her first day in office.

A bipartisan group of lawmakers had passed Medicaid expansion five times before voters took matters into their own hands and enacted the law through referendum.

Former Gov. Paul LePage, with the complicity of Republicans in the Maine House of Representatives, had blocked Medicaid expansion and refused to implement the law even when it was passed.

Republicans – including the ghost of LePage – have demanded that Medicaid expansion be funded “sustainably” and are harping on costs. They’ve also said that they won’t support new tax revenue to fund expansion, cuts to other programs or the use of one-time monies.

That doesn’t leave a whole lot of options. In fact, their calls for sustainable funding are little more than a rhetorical attack designed to further stymie providing health care to nearly 70,000 Mainers.

The state budget works like this in normal times: The governor proposes a budget, the Legislature considers it and makes changes before passing it and sending it to the governor’s desk, where she can sign it, veto it or allow it to become law without her signature.

In between introduction and passage, there are scores of public hearings, work sessions and negotiations – all designed to earn the budget the support of two-thirds of the members of the Legislature.

The two-thirds is required to pass the budget as an “emergency,” which means it can take effect immediately and not wait until 90 days after the Legislature adjourns before taking effect. Unless the Legislature passes the budget and adjourns in March, they’re going to need Republican support for the budget to kick in at the start of the new fiscal year on July 1.

While it’s true that Medicaid is one of the largest and costliest programs in state government, it is also just another program. Republicans who demand some sort of magic funding formula for Medicaid, but not other programs, are really just looking to stop the expansion. Is there really any funding mechanism that the majority of Republicans would support? Let’s be honest.

Every budget cycle – and sometimes in between with mid-course corrections and additions called supplemental budgets – the governor and the Legislature set funding and spending priorities based on available revenue.

Sometimes they use one-time money to solve problems, sometimes they raise revenue and sometimes they cut spending, along with a whole host of other budgetary sleights of hand. So it has been, so it will always be.

There’s nothing peculiar about Medicaid that would make it fall outside of this cycle. To say or pretend otherwise is just a trick meant to undermine the law and prevent people from getting health care.

There’s money in the state Medicaid account right now to fund expansion. There are one-time dollars from a tobacco settlement available right now. The state is running a surplus right now, with dollars available for programs such as Medicaid expansion.

After a wipe out election in which health care was a major factor, Republicans have to decide if they’re going to buck the will of the people again and continue to put up roadblocks to expansion or whether they’ll agree to a reasonable funding plan.

David Farmer is a public affairs, political and media consultant in Portland, where he lives with his wife and two children. He was senior adviser to Democrat Mike Michaud’s 2014 campaign for governor.