Why is Nobody Talking About Maine’s Attempt to Expand Medicaid By Popular Vote?

Maine stands at a crossroads that could affect the nation’s healthcare system and the 2018 midterm elections, and nobody seems to know about it.

Today, while there are many important state special elections to watch, Maine’s referendum on Medicaid expansion could have some of the furthest-reaching consequences. The referendum marks the climax of a long battle in state government: on one side, the state legislature, and on the other, Governor Paul LePage. The state legislature has repeatedly put forward bills to expand the state’s access to Medicaid under the Affordable Care Act, while LePage says that would be too expensive. Incidentally, The New York Times shows that LePage’s administration seems to be wildly overestimating the costs to the state in its report on the referendum. Republican senator Susan Collins hasn’t weighed in—her staff says she never does on referendums—despite her opposition to Obamacare’s repeal in the senate.

We won’t go into why Paul LePage is a bad person and a bad governor, but you can find a pretty good summation here that includes his racist comments, his petty political squabbles and his assertion that America should bring back public executions.

Instead, one thing stands out as LePage’s most enduring facet: his vetoes. In order to pressure state lawmakers into voting for initiatives he supported, he began vetoing bill after bill they put forth, regardless of how necessary the bills were. The man has vetoed literally hundreds of laws for no reason other than to punish his own colleagues for perceived slights. Case in point: LePage has vetoed this very effort no less than five times.

So along comes the referendum, which, if successful, would bypass LePage and put the issue directly to the state legislature. While Republicans may have a narrow majority in the state senate, The NYT reports that they would be unlikely to oppose the results of the referendum, since they’ve already voted in favor of it multiple times.

The one real obstacle to the referendum seems to be voter turnout. First, Mainers aren’t entirely convinced that Medicaid expansion is financially feasible, as they expanded it once before just over a decade ago, and the results were not favorable. Maine ended up falling behind on Medicaid payments and increasing debt. Second, there isn’t a large-scale national or local election to drive people to voting booths, so the referendum isn’t getting the increased attention of a political race.

But despite the lack of awareness, both at the local and national level, certain people are watching this vote very closely. This referendum is the first of its kind, the first that could potentially thwart Republican holdouts in their efforts to stop the rollout of Obamacare in their states. There are 18 other states that currently refuse to expand access to Medicaid under the Affordable Care Act, and you can bet your ass that lawmakers in those states are watching the results of this referendum like hawks. A victory for expanded Medicaid here could signal to politicians that they may need to revise their positions on healthcare come 2018.

Tens of thousands of poor Maine adults would receive healthcare coverage if this bill were to pass. If the other 18 holdout states did the same, that number would go up over 2.5 million. The medical futures of many people could hang in the balance of this vote, so even though there hasn’t been much mainstream coverage, even though there isn’t a political race, make sure you keep an eye on it.