A woman’s leg was caught in the gap of an Orange Line train — and she begged for no ambulance due to the cost
by Maria Cramer - The Boston Globe - July 2, 2018
When a 45-year-old woman’s leg became caught in the gap between an Orange Line train and the platform Friday afternoon, she was in agony. The cut on her leg went down to the bone.
Beyond her pain, she had another fear. Shaking and crying, she begged people not to call an ambulance. “Do you know how much an ambulance costs?” she wept.
Her fellow passengers rushed to her aid. One man stood behind her so she could lean on him. Another passenger placed a cold bottle of water to her leg. And at least 10 people pushed on the car together, moving it just enough for the woman to pull free, according to a video of the accident the MBTA released Monday.
Marleny Polanco said she was at Mass. Ave. Station at the peak of rush hour when she heard the woman scream. Immediately, a group of men were there to help push the train away from the platform, Polanco said. “It all just happened so fast,” Polanco said. “I think within a minute or so, she was able to pull her leg out.”
A few people helped wrap her leg in a compress, Polanco said. Despite her injuries, the woman did not want anyone to call an ambulance, saying it would cost her thousands of dollars.
Polanco, who lives in Lawrence, said she didn’t think the accident was the woman’s fault, saying the gap between the platform and the train cart was too wide.
The gap was 5 inches, MBTA officials said.
The woman’s painful calculation that she could not afford an ambulance has drawn wide attention after a Globe reporter who witnessed the aftermath of the platform accident posted about it on Twitter. The post has received more than 6,700 retweets and 13,000 likes.
On Monday, the New York Times editorial board wrote about the accident under the headline “This Tweet Captures the State of Health Care in America Today.” On Twitter, people registered their outrage that the cost of medical treatment could prevent someone from seeking urgent care.
According to a police report, the woman suffered no broken bones but her left thigh suffered a “serious laceration, exposing the bone” and would need surgery. She was taken to Boston Medical Center.
The accident happened at 5:30 p.m. Emergency medical officials arrived within minutes, according to the police report.
Jim Hooley, chief of Boston EMS, said an ambulance transporting people within the city would cost between $1,200 to $1,900 at most for patients with the most pressing needs, like resuscitation.
“We just worry about taking care of people,” Hooley said. “We don’t want to cause them more stress. We just want to reassure them that nothing bad is going to happen to them because of their inability to pay.”
The “pleasant ambiguity” of Medicare-for-all in 2018, explained
by Dylan Scott - Vox.com - July 2, 2018
Democrats across the country are running on three simple words, recognizable to every American: Medicare for all.
“There’s no more popular brand in American politics than Medicare,” says Adam Green, co-founder of the lefty Progressive Change Campaign Committee (PCCC). “Our hope is that Democrats wrap themselves in the flag of Medicare in 2018.”
In Democratic primaries around the country, Medicare-for-all candidates are winning — from Kara Eastman in Nebraska to Katie Porter in Orange County, California, to Alexandria Ocasio-Cortez in the Bronx, the message is resonating.
“The system we have, the status quo is not acceptable,” Porter told me when I covered her primary race in May. “We’re questioning whether we can rely on major players, like health insurance companies, to continue to be reliable partners in delivering health care.”
Even before these candidates started winning, polling was showing that Medicare-for-all is really popular: 62 percent of Americans liked the sound of it in last November. Almost every single rumored 2020 candidate in the Senate has backed Sen. Bernie Sanders’s Medicare-for-all bill. It’s clear the idea is in ascendancy among Democrats.
But someday, a reckoning will come. When Democrats hold power again — especially control of Congress and the White House — they will be expected to actually deliver on these Medicare-for-all promises. And when that day arrives, the party will have to decide whether they want to blow up America’s current health care system to build something new or figure out a less disruptive path, but risk falling short of truly universal coverage.
So even now, there is some jockeying among Democrats to define those three little words.
What does “Medicare-for-all” actually mean?
As popular as Medicare-for-all is, the slightly more vexing question is what it actually means.
Historically, Medicare-for-all has meant single-payer health insurance, a national government-run program that covered every American and replaced private coverage entirely, similar to the government-run health care programs in Canada and some European countries.
Then-Rep. John Conyers (D-MI) first introduced the Expanded and Improved Medicare for All Act in 2003. Conyers has since been disgraced by sexual harassment allegations but the idea lives on. It’s now sponsored by Rep. Keith Ellison (D-MN)and it is still a single-payer proposal. So is Sanders’s Medicare-for-all bill, a cornerstone of his unexpectedly resonant 2016 presidential campaign.
But these days, other plans are falling under the Medicare-for-all umbrella. Some progressives, like Green, are even comfortable with the term being applied to the various proposals to allow all Americans buy into Medicare. Some of those plans used to be branded as a “public option”; they would not end private insurance that more than half of Americans get, usually through work, as a true single-payer would. But these plans would also not provide the same guarantee of universal coverage that a single-payer system does.
“For anybody who supports Medicare-for-all single payer, what better way to debunk the right wing lies than to allow millions and millions of Americans to voluntarily opt into Medicare and love it?” Green told me in our interview. “As a political strategy, having Medicare-for-all be a broad umbrella where any candidate can embrace some version of it... that moves the center of gravity in the Democratic party.”
In 2018, with control of Congress at stake, nobody is taking up arms to insist that their version should be orthodoxy. What we know for certain is that Medicare-for-all is popular, and so Democrats of all stripes want to campaign on it. Governing comes later.
What does the public think about Medicare-for-all versus single-payer health care?
Ultimately, the direction the Democratic party goes in may have a lot to do with how far the public is willing to go.
One chart from the Kaiser Family Foundation, the gold standard for health policy polling, sums up why there is any debate at all about the meaning of Medicare-for-all.
Medicare-for-all gets nearly two-thirds support, but a “single-payer health insurance system” is a little more divisive: 48 percent have a positive reaction, and 32 percent have a negative reaction; the gap between favor and disfavor closes considerably. Medicare buy-ins poll the highest, with the support of three-fourths of Americans, including 6 out of 10 Republicans.
You could absolutely argue these numbers still seem pretty strong for single-payer described as such, given the conventional wisdom that such a plan is unworkable. But it is undoubtedly true that Medicare-for-all, as a slogan, is more popular — as are some of these more incremental policies, like giving people the option of buying into Medicare.
The “pleasant ambiguity” of Medicare-for-all, explained
Back in 2012, a group of progressive activists and Democratic lawmakers got together to talk about what they would do if the Supreme Court ruled the Affordable Care Act unconstitutional. That looked like a real possibility, and they agreed on a new campaign to keep pushing for universal health care.
Democrats planned to run on a platform of Medicare-for-all if the Court struck the law down. At that point, the Conyers single-payer bill had been around for nearly a decade, but the PCCC’s Green says that on that day and in that room, some people heard Medicare-for-all and thought of a single-payer system. Yet others heard the same thing and thought of something that looks more like a public option. From his perspective, those different ideas aren’t a problem.
“There is a pleasant ambiguity and more of a north star goal nature around Medicare-for-all,” Green said. “This really does not need to be a huge intra-party battle. Why get in the weeds during the campaign?”
Voters themselves seem to like the sound of Medicare-for-all, even if they themselves don’t always agree on what it means. BuzzFeed’s Molly Hensley-Clancy reported on this phenomenon while covering Eastman’s campaign in Nebraska ahead of the May primary:
[C]onversations with more than two dozen Omaha voters reveal a dynamic that polling, too, has begun to capture: When some moderate and left-leaning voters say “Medicare for All” sounds like a pretty good idea, they aren’t actually thinking about single-payer health care. Instead, they’re thinking about simply expanding the program to include more seniors or children, or offering a public option that people can buy into.On one warm May day a week from the primary, Phil, a devout liberal, told Eastman the story of his wife’s brain cancer — rejected by Medicaid, and still too young for Medicare, they’ve barely been able to afford pricey experimental treatments.He likes the sound of Medicare for All, he said, but wouldn’t want everyone to be part of a single-payer, government-run system. “I wouldn’t want one system,” he told BuzzFeed News. “I wouldn’t want that.”
We heard similar ambiguity when Vox conducted some focus groups with Hillary Clinton voters in suburban Washington, DC, last fall. Those voters, particularly the ones who currently had their own insurance through work, liked the idea of having a choice, having an option. They also liked the sound of Medicare-for-all, but a top-to-bottom overhaul of the American health care system made them nervous.
“To me, [single-payer] sounds like it’s somehow complete overhaul of everything, whereas Medicare-for-all sounds like warming people up to the idea using the structure that’s already in place to deliver that care,” Dennis, a 34-year-old Hillary Clinton voter in Bethesda, told us.
One of the things that made Democrats the most nervous about single payer is how political health care has become. They see how Trump has attacked Obamacare, and they see future Republican administrations meddling with single-payer health care as a real possibility. That could be a sticking point for some Democratic voters, especially those who are better off and already get good insurance through work.
Medicare-for-all is uniting Democrats for now — but it could divide them later
That explains why there’s this fledgling competition over what Medicare-for-all is really describing.
The best example might be the health care plan from the Center of American Progress, which is, tellingly, called “Medicare Extra For All.” It’s a seriously ambitious plan, one that would achieve universal coverage through a combination of government plans and private insurance, while preserving employer-based insurance for those who want it. But it is not single payer. And it is notably produced by an organization closely aligned with the Democratic establishment.
“To the extent there will be moments where we have to bring clarity to what Medicare-for-all means for us on the progressive side of the house, compared to other people who want to dance around the issue, we will do that,” Nina Turner, who leads the Sanders-affiliated Our Revolution, told me. “For us, at Our Revolution, it is Medicare for all, the whole thing, for everybody in this country.”
The scars from the Obamacare reveal themselves in this debate. For all the health care law has achieved, it also showed the limits of incrementalism. Even Medicaid expansion, the closest thing the law had to a single-payer pilot, was undermined by the Supreme Court by allowing Republican-led states to refuse it. The Obamacare insurance markets have been susceptible to sabotage from Republicans in Congress and the Trump administration.
Yes, the uninsured rate has reached historic lows under Obamacare, but 10 percent of Americans still lack coverage. Democrats will be faced again, at some point, with a choice between a more incremental approach, like the Medicare public options introduced by some Democrats in Congress, or a sweeping overhaul like single-payer. They can put it off for a while and campaign, as Green suggests, on whatever Medicare-for-all means to voters. But eventually that debate will need to be had.
Its outcome is far from certain. Eastman, one of Medicare-for-all’s most notable champions so far in 2018, described the dilemma perfectly.
She unambiguously supports single-payer Medicare-for-all. But “with the current Congress, with the current president, is that feasible?” she said. “I think you have to be practical about what’s happening in our country.”
Yet even if she recognizes the political realities of the moment, she wants Democrats to be bolder in their agenda.
“We have to stop backing off from this issue,” Eastman said. “That’s one of the problems with the ACA. It didn’t go far enough.”
by Bagehot - The Economist - June 28, 2018
THE National Health Service’s 70th birthday is turning into an extravaganza. The government has given the service a £25bn ($33bn) present to mark the anniversary, which falls on July 5th. The BBC broadcasts daily encomiums to the wonders of free health care. Jeremy Corbyn, Labour’s leader, wore a large badge celebrating the NHS’s birthday at prime minister’s question time.
The NHS is the most popular institution in the country. In a survey by Ipsos MORI last year, 77% of respondents believed that it should be maintained in its current form and 91% supported its founding principles, that health care should be free at the point of delivery and funded by general taxation.
It is so popular because it is more than just a public service. It is also an embodiment of British values at their best: compassion and decency; waiting in line rather than barging ahead; being part of a national community rather than a collection of self-seeking atoms. These values were central to Britain’s conception of itself in 1948 when the Labour Party founded the NHS as part of its New Jerusalem. Many people cling fiercely to the health service today precisely because it is a reminder of a more egalitarian society and an antidote to our self-seeking times.
Walter Bagehot, the great 19th-century editor of The Economist, argued that the British constitution was divided into two branches: the dignified, which represents the nation in its symbolic form, and the efficient, which gets the work of the world done. The NHS is the most-loved British institution because it straddles this divide. It is dignified because it represents Britons’ collective view of themselves as a decent bunch of people, and efficient because it treats more than 1m patients every 36 hours.
The fact that the NHS spans the dignified and efficient divide not only explains why its birthday is being celebrated with such enthusiasm. It also explains why so much of this enthusiasm is coupled with nonsense and exaggeration. It is hard to remember a time other than a royal wedding when so many commentators have uttered so many half-truths—or indeed non-truths—with such grave conviction. Three myths are particularly cloying.
The first is that Labour summoned up the NHS from thin air; that before 1948 the poor died in the streets but after 1948 they were suddenly equipped with new hips and false teeth. In fact, the government inherited a rich patchwork of charitable hospitals, school medical services and employer- and government-subsidised health care. The 1945-51 Labour government didn’t build a single new hospital or add significantly to the number of doctors. Its achievement was to nationalise a patchwork system and make it free at the point of delivery.
The second is that the NHS is a unique embodiment of compassion. Aneurin Bevan, the health secretary who created it, sold the NHS as proof that, even as Britain was ceding global leadership to America and the Soviet Union, it was still a superpower in one vital area. “We now have the moral leadership of the world, and before many years we shall have people coming here as to a modern Mecca, learning from us in the 20th century as they learned from us in the 17th century,” he declared. But there was far more than morality at play. The service’s roots are in the “national efficiency movement” of the Edwardian era. The 1905-15 Liberal government introduced medical inspections for schoolchildren in 1907 and national health insurance in 1911, among other reforms, because, in Lloyd George’s words, “The white man’s burden had to be carried on strong backs.” After 1948 the NHS was part of a warfare-welfare state that spent 10% of GDP on defence and maintained a large conscript army because it worried that war with the Soviet Union was imminent.
The NHS does a middling job of turning compassion into care—certainly better than America, but worse than several continental countries that rely on compulsory insurance backstopped by the government. The Nuffield Trust, a health think-tank, points out that Britain has markedly fewer doctors and nurses per person than similar countries, and fewer CT scanners and MRI machines. It also has higher rates of mortality for problems such as cancer, heart attacks and strokes. On the positive side, it is excellent at providing long-term care and value for money.
The final myth is that the Conservative Party is perpetually bent on selling off the NHS to the highest bidder. There may be a few ideologues on the right who dream of replacing the health service with an insurance-based system or an American-style public-private mix. But they are outliers. Conservative right-wingers have shied away from acting on their principles. One of the first big boosts in NHS spending came in 1962 when Enoch Powell, an early champion of the free market, splashed out on 90 new and 134 refurbished hospitals. Mainstream Conservatives like the NHS because it gives the government a way of controlling health spending and ensuring value for money.
Easy on the champagne
It may seem a bit churlish to turn up to a birthday party and spit on the cake. Myths can serve a useful function in boosting morale, particularly when morale has been eroded by a decade of austerity. But the myths that surround the NHS have also done harm. They have given the Labour Party an excuse to demonise Conservative reforms as “backdoor privatisation” rather than subjecting them to serious criticism. They have discouraged the NHS from learning from other countries. They have made it impossible even to think about boosting NHS revenue by charging patients a nominal sum for visiting the doctor. They may even have allowed scandals to go uncovered because nobody can bring themselves to blow the whistle on saintly NHS workers. Britain is right to celebrate a service that provides all Britons with free health care at a reasonable cost. But they are wrong to treat the NHS as an object of awe rather than a human institution with all the imperfections that being human entails.
Expanded Medicaid in limbo on first day that Mainers can apply for it
by Marina Villanueva - Portland Press Herald - July 2, 2018
AUGUSTA — Maine is the only state with voters who have approved expanding Medicaid to low-income residents, but the start of expansion originally set for Monday is in limbo as a legal battle between the fiscally conservative governor and advocates continues.
Last fall, nearly three out of five voters approved the expansion of Medicaid to cover an estimated 70,000 Mainers. It was the first time since former President Barack Obama’s Affordable Care Act took effect four years ago that the expansion question has been put to voters.
Roughly 11 million people in 31 states have gained coverage through the expansion of Medicaid, the state-federal health insurance program for lower-income Americans. Since Maine’s vote last fall, Virginia lawmakers voted to expand Medicaid, and expansion initiatives are set to appear on ballots in Utah and, potentially, in Nebraska and Idaho.
Late last year, Republican Gov. Paul LePage swore to block expansion unless lawmakers provided funding under his terms to pay for Maine’s share of expansion. Last month, lawmakers sent him the funding bill he demanded, but LePage vowed to veto it, possibly Monday, partly because he says it would harm the state’s economy.
Meanwhile, the state faces lingering questions about the fate of expansion, the cost of the governor’s efforts to block Medicaid and the impact of potential work requirements.
LePage had vetoed five attempts by the politically divided Legislature to expand the program and take advantage of the federal government picking up most of the cost. That led to the citizen initiative where voters approved expansion, but the governor ignored an April 2018 deadline to submit the necessary paperwork to eventually receive more than $500 million in annual federal funding to pay for most of it.
Advocacy groups and potential Medicaid recipients then filed suit, and a Superior Court judge sided with them, ordering the LePage administration to file a state plan amendment with the federal government that would set the health coverage in motion.
But the administration appealed the order, and the Maine Supreme Judicial Court said LePage doesn’t have to file the paperwork during the appeal. Legal arguments are set for July 18, and advocates are encouraging low-income Mainers to apply for Medicaid on Monday even though the LePage administration is not ready for a surge in applicants.
The governor disputes the estimated, first-year cost of about $30 million after savings and says lawmakers should recall their “hasty, ill-conceived” funding plan that relies on surplus and tobacco settlement funds. “We cannot afford to return to the days of out-of-control spending on Medicaid and a $750 million debt to our hospitals,” he said Friday.
Peter Miller, an Ellsworth man who lost Medicaid eligibility in 2013 under LePage-era cuts, said he hasn’t followed the political and legal twists and turns.
“I gave up on the hope of this going my way,” said Miller, who cannot afford weekly treatments for a blood clot and resorts to keeping old asthma inhalers in a bowl in his living room. He said his pay as a prep cook isn’t enough for him to qualify for financial assistance to help him afford health insurance under Obama’s law.
“I’m just hoping that I survive,” he said.
LePage has said he considers Medicaid another form of welfare that will bankrupt his state. His plan to require certain recipients to work and pay premiums exempts those who prove they’re physically or mentally unable to work.
Four states – Kentucky, Indiana, Arkansas and New Hampshire – have had their 20-hour-a-week work requirements approved by Republican President Trump’s administration, a development that has won over some Republican lawmakers long opposed to Medicaid expansion. Virginia is set to seek federal permission for such restrictions, while Utah wants a limited Medicaid expansion with work requirements.
But the future of such work requirements is unclear as seven states, including Maine, await federal permission for their own plans. On Friday, a federal judge blocked Kentucky’s work requirements and has ordered the Trump administration to reconsider the program.
LePage’s plan to limit Medicaid coverage to three months in a 36-month period for those who don’t meet work requirements has been little-discussed as advocates lawyer up, but observers like Maine Primary Care Association Board President Martin Sabol said they’re worried. LePage’s administration predicts an unknown number of “able-bodied” adults will lose coverage under a plan that could save Maine roughly $130,000 annually.
“There often aren’t a whole lot of jobs available to people who don’t have a lot of job skills,” said Sabol, who directs health services at a community health care center serving 5,500 patients. “Folks are going to be losing their coverage, and that’s going to mean we’re going to have a whole lot more uncompensated care.”
Meanwhile, LePage’s legal costs are mounting. Democratic attorney general and gubernatorial candidate Janet Mills has refused to represent LePage in the ongoing Medicaid lawsuit, and has allowed him to retain Boston lawyer Patrick Strawbridge.
LePage’s office hasn’t responded to requests for Strawbridge’s billing for Medicaid litigation. But Maine’s online database of governmental spending shows Maine’s risk management claims fund paid $16,478 on May 25 to Strawbridge’s firm Consovoy McCarthy Park. The fund has paid out $92,000 this year to the firm, which has represented the governor in four legal matters in the past year.
Commentary: Eligible Mainers should assert rights, sign up for expanded Medicaid
by Robyn Merrill - Portland Press Herald - July 2, 2018
AUGUSTA — Medicaid expansion – and coverage for more than 70,000 Mainers – is the law.
Thanks to the hard work of everyone who worked to pass this law in November and support its implementation, thousands of our friends and neighbors won’t have to choose between putting food on the table and filling a prescription.
People who are sick and struggling financially will now be able to get the care they need to get well, to keep that job, to continue caring for a loved one, to have a better quality of life.
Whether voters supported Medicaid expansion to save lives, or to bring substantial economic benefits and jobs to our state, Mainers passed this law with nearly 60 percent support last November.
As a result, people will become eligible for health coverage Monday under the law.
Unfortunately, Gov. Paul LePage and his administration have done nothing to implement the law the voters passed. Nonetheless, it’s critical for Mainers who think they are eligible to apply for Medicaid, also known as MaineCare in Maine.
To be clear, it’s unlikely that LePage or the Department of Health and Human Services will allow people to access health care services right away – they’ve acknowledged they have yet to do anything to implement the law – but by signing up, eligible people will protect their rights to health care.
And, if they are ultimately approved for coverage, by signing up now eligible Mainers could protect their right to retroactive coverage, meaning their medical bills would be covered starting at the beginning of the month they apply.
Additionally, if DHHS fails to make a decision on an application within 45 days, applicants become eligible for temporary coverage, unless the applicant caused the delay.
It’s confusing, for sure. And that confusion isn’t an accident.
It’s the direct result of the actions and inactions of LePage and his administration, which have demonstrated time and time again that they will stop at nothing in their efforts to deny health care to Maine people. LePage has made clear that he believes that some people deserve health care, while others do not. The voters disagreed.
We encourage people to submit an application. That’s the best way for Mainers to protect their health care rights.
Maine Equal Justice has developed an online tool available at www.mejp.org to help people determine if they are eligible for coverage through expansion.
Mainers who believe they might be eligible can also call Maine Equal Justice’s hotline at 866-626-7059 for help with applying and to understand their rights.
Here’s where the process stands. In November, voters overwhelmingly approved Medicaid expansion, but LePage refused to implement it. In April, a group of advocates and affected individuals sued to force the LePage administration to implement the law.
On June 4, the Maine Superior Court agreed with the people and ordered the LePage administration to begin the process of implementation by filing a state plan amendment, which allows the state to draw down federal funding, 90 percent of the total cost, to support expansion.
On June 20, the Maine Supreme Judicial Court put that order on hold until July 18, when it will hear oral arguments on the administration’s request to hold off on submitting the state plan until the appeal is decided. That order does not affect the July 2 date in the Medicaid expansion law.
Also on June 20, the Legislature passed legislation to fund the full cost of expansion based on the cost estimated by the governor, taking away his last excuse for blocking access to health care. We are grateful to the legislators from both sides of the aisle who voted to support the will of Maine voters.
And even though LePage has vetoed the funding bill, the funds are available to provide health coverage to people who are eligible until at least May 2019. The law the voters passed is still binding.
Importantly, the Legislature will have an opportunity to override LePage’s veto and make sure that people get the health care they deserve sooner rather than later. We are counting on them to uphold the will of the voters.
The law is the law. Mainers voted for more health care and that stands. Too many Mainers have waited too long for life-saving health care. The voters and the Legislature have spoken and now it’s time to move forward.
By signing up for coverage now, eligible Mainers protect themselves, assert their rights and take one more step toward getting the health care that we all deserve.
LePage Vetoes Medicaid Expansion Bill, But Supporters Encourage Mainers To Enroll Anyway
by Steve Mistler - Maine Public - July 2, 2018
Under the Medicaid expansion law that voters approved last November, Mainers who earn less than 138 percent of the federal poverty level could be eligible for MaineCare, the state's name for its Medicaid program, starting Monday.
But the LePage administration has resisted implementing the law. The Governor is challenging a recent court ruling that orders him to submit an application to the federal government, and Monday he also vetoed a bill that would fund expansion.
But expansion supporters are urging roughly 70,000 low income Mainers to ignore the political uncertainty, and apply for the health care coverage now.
Under the new law, an individual earning less than $16,600 per year, or a family of four earning less than $34,000 a year, could be eligible for Medicaid coverage.
But because the state hasn't taken any steps to actually enroll people in the program, the Department of Health and Human Services may not be able to approve applications.
But Kathy Kilrain del Rio, a policy analyst for Maine Equal Justice Partners, says that should not deter eligible mainers.
"The Department of Health and Human Services must begin to take applications, and it will," says Kilrain del Rio.
The Maine Equal Justice Partners led the ballot initiative that voters approved last year.
During a press conference at Greater Portland Health, Kilrain del Rio urged Mainers who think they're eligible for Medicaid to fill out the 10-page application.
"The sooner people apply, the sooner they got coverage," Del Rio says.
But just how soon is a mystery.
The Governor, who has beat back numerous attempts to expand Medicaid in the Legislature, has done nothing to implement last year's referendum law.
The federal government pays for over 90 percent of the costs for expansion coverage, but LePage has repeatedly said he can't implement the law until the Legislature approves the estimated $50 million a year it's projected to cost the state.
Last week the Legislature passed a $60 million funding bill, but the governor vetoed the bill on Monday, fulfilling a promise he made during his radio address in which he described the proposal as a gimmick pushed by Democratic House Speaker Sara Gideon.
"It's just another move by Speaker Gideon to look they're funding Medicaid expansion, but they aren't,” he says.
LePage says the funding bill relies on one-time funding when money for ongoing costs is needed.
But he's also indicated that he will veto just about any other funding mechanism that lawmakers could pass and supporters of Medicaid expansion have so far been unable to muster enough votes to circumvent LePage.
In the interim, the LePage administration has been sued by Maine Equal Justice Partners and several would-be Medicaid recipients in an attempt to force him to implement the law.
Confusing the matter is that LePage’s attorneys have argued that he can't implement the law until the Legislature approves a funding bill. A superior court judge ruled last month that LePage has to implement the law, but the governor's attorneys have appealed to the Maine Supreme Judicial Court.
Maine Equal Justice Partners attorney Charles Dingman said Monday that the oral arguments scheduled for later this month have nothing to do with the push to enroll potential Medicaid recipients now.
"People applying for care is something that should happen because people need the coverage for the care. It's not a litigation strategy," he says.
Supporters say applying for benefits now will help ensure that Mainers who qualify for coverage will eventually get it and, potentially, get retroactive coverage if the political and legal disputes continue until LePage leaves office next year.