PORTLAND, Maine (AP) — Residents in this rural state besieged by a heroin epidemic, mill closings and an aging population were deciding Tuesday whether to deliver a rebuke to Republican Gov. Paul LePage and join 31 other states that have expanded Medicaid under former President Barack Obama's health care law.
The statewide referendum marked the first time since the law took effect that the question of expansion of health care for the poor has been put before voters, not politicians, making it a bellwether for support for the Affordable Care Act.
The ballot measure comes after Maine's governor vetoed five different legislative attempts to expand the program. It also acts as a bookend to a year in which President Donald Trump and congressional Republicans tried and failed repeatedly to repeal "Obamacare."
Passage of the proposal would mean an estimated 70,000 people in Maine would gain health coverage. About 268,000 people currently receive Medicaid in the state.
A recent poll showed about two-thirds of respondents supported the expansion in Maine, a state that divided its electoral votes between Democrat Hillary Clinton and Republican Donald Trump in the 2016 presidential election.
But turnout could be a factor in the outcome. The state's top election official, Secretary of State Matt Dunlap, predicted a modest turnout on the order of 20 to 30 percent of the voting age population in Maine.
For supporters and opponents of "Obamacare," Maine's question took on the form of a referendum on one of the most important pieces of the Affordable Care Act.
But in the nation's Northeast corner, the issue was personal to many in a rural state that has the country's oldest population and the region's lowest wages. The state is also grappling with an epidemic of opioid overdoses and addiction, and expanded Medicaid could help addicts, expansions proponents say.
LePage opposes giving able-bodied adults more access to Medicaid, and often summarizes his argument by saying: "Free is expensive to somebody." He also warned that he would have to divert $54 million from other programs — for the elderly, disabled and children — to pay for the state's share of the expansion if it's fully implemented.
Mainers For Health Care, a group that supports expansion, touted the proposal as a "commonsense move" to ensure health care coverage for more people. Maine's hospitals also support the Medicaid expansion and say charity care costs them over $100 million annually.
The initiative's supporters have reported spending about $2 million on their campaign, with hundreds of thousands of dollars coming from out-of-state groups. By comparison, the lead political action committee established to oppose the measure has spent a bit less than $300,000.
This may not be the last state vote. Backers of Medicaid expansion in Idaho and Utah have started similar efforts to get the question on the 2018 ballots in their own states.