Republican Rep. Robin Weisz is a farmer who grows corn, beans and wheat. He describes himself as coming from a “very conservative background.” And on Feb. 27 he cast a vote to expand Medicaid under the Affordable Care Act.
Weisz doesn’t come from Maine. He lives in Hurdsfield, N.D., and for 18 years has served in the North Dakota Legislative Assembly, the last three sessions as chairman of the Human Services Committee. Three-quarters of the House are Republicans. The Senate is 70 percent Republican. The head of the state is Republican Gov. Jack Dalrymple, who supports expansion.
For the North Dakota House, which voted to expand coverage to people not traditionally covered under the public health insurance program, the decision was less a question of politics and more one of economics. Weisz said he never liked the idea of the Affordable Care Act, but the state would lose more by not participating in expansion.
“It doesn’t matter what I think of the act. I have to do what’s best for my constituents and the state,” he said in an interview.
It’s a sentiment that could spread to the Republican Party in Maine. Gov. Paul LePage strictly opposed Medicaid expansion in public statements until this week when his office said it has started talking with the Obama administration. Beginning a dialogue is far from supporting expansion, but it is a first step.
North Dakota would pay more during the next decade if it extends Medicaid to able-bodied parents and adults without children who earn up to 133 percent of the federal poverty level. But it would also receive much more from the federal government. According to a Kaiser Family Foundation analysis, the state would likely pay 3.9 percent more for Medicaid but reap a 28.4 percent increase in federal funding.
Based on the same Kaiser study, Maine would be one of 10 states to see the amount of money it spends on Medicaid actually decrease during the next decade — by 3.8 percent; the federal share is projected to increase 11.4 percent.
The U.S. Supreme Court said expansion was optional for states when it ruled the health care law constitutional in June. Weisz’s advice is for Maine to determine how expansion would affect the cost of premiums, to talk to hospitals and find out how their bad debt levels would change, and to figure out costs connected to the required health-care exchanges — marketplaces formed under the Affordable Care Act where people can buy an insurance policy and receive income-based subsidies to help pay for it.
“You’ve got to put those numbers together and decide whether it makes sense,” he said. “It was the numbers that made the difference.”
For some, the decision will also be rooted in a desire to improve people’s health and quality of life. This week, Maine Sen. Tom Saviello, R-Wilton, said that Maine should expand Medicaid. He’s the first Republican legislator in Maine to take that public stand.
“The argument comes back to health care,” he said.
He represents people in rural Franklin County who are not insured and sometimes wait until a condition becomes severe to seek medical help. Then they must rely on charity care at Franklin Memorial Hospital. If people have insurance, he said, they are more likely to take preventative care, leading to savings for hospitals — and premium holders — and a healthier population.
Saviello said he is willing to sign on to legislation sponsored by Rep. Linda Sanborn, D-Gorham, which would have Maine participate in the expansion.
“I do what I think is the right thing, and this is after talking to a number of people and a lot of self-reflection,” he said.
It’s wise for Maine leaders to study the issue. The Maine Department of Health and Human Services will have to make sure it can logistically support expansion; and lawmakers should insist that hospitals move toward a system where they are paid for the quality, not quantity, of care provided. There should be a clear, transparent way to track the effects of Medicaid expansion.
The governor can have a hand in making expansion as successful as it can be. At the very least, he can consider the arguments of those in and outside both his party and state.