No, I am not talking about Maine as a bellwether state for presidential elections. I am talking about Maine as a kind of bellwether state on using the ballot initiative process to adopt ACA Medicaid expansion. The ballot measure passed. Now, the issue is the funding for the estimated $50 million Maine will need to draw down an estimated ten times that much in Medicaid dollars. That makes all eyes turn to the Maine legislature, where the funding battle will be fought. But will they have to fight fast because Maine has a very part time legislature?
No. If the initiative requires spending beyond available state funds and does not provide a funding mechanism, the effective date of the initiative can be delayed until 45 days into the following legislative session. Question 2 was written to give the Department of Health and Human Services (DHHS) 90 days after its effective date to submit a plan to the federal government and 180 days to begin expanded coverage. So, maybe they get to continue to fight slow in Maine, after all.
We are told Utah and Iowa are watching this ballot measure approach. They need to know this would be a long slow slog. After all, even the wording of the ballot question and its official summary contained within it a microcosm of the entire debate over ACA Medicaid expansion: is it health care insurance or is it welfare? The actual voter information in Maine eventually adopted the "coverage" compromise but, make no mistake, the fight over the characterization of the Medicaid expansion does not end in Maine.