Medicaid vote may send national message on populism

A Maine referendum next week may tell a lot about where voters across the country stand on one of the central political issues of the day: whether government should be reduced or expanded to meet public needs.

It may be obvious that the vote will send a message to Washington about public support for one of the key features of the Affordable Care Act – the expansion of Medicaid to cover many uninsured.

But the referendum’s importance may also tell the country much more.  Are the populists on the rise, as they maintain?  Or does support remain for government action on a matter as controversial as health care coverage?

National polling shows sharp divisions between populists, who want cutbacks and seek to dominate the Republican Party, and Democrats, who send unclear messages but appear to want government to provide more assistance to the public.

The populists believe they can displace traditional Republicans in Congress next year, because their anti-government appeal responds to where the country is moving.  They use allegiance to President Trump as their litmus test.  Though polls show his popularity falling, they scorn polls and say the only measure is an election.

Some idea about where voters stand may come from the Maine vote on Medicaid expansion.  It is the only state thus far where the question will be decided by popular vote.  Most states, under control of either party, have accepted expansion.

Maine is a particularly good test case on populism versus the government.  In November 2016, by a relatively small margin, it voted for Hillary Clinton, the Democratic presidential candidate.  At the same time, by a similar margin, it voted against background checks in private gun sales, supporting a position identified with the GOP.

Medicaid opponents claim its expansion will raise state costs.  They reject new costs, which could mean higher taxes in a state with already relatively high rates.  They say that the uninsured can continue as charity cases in local hospital emergency rooms.

This view is typical of efforts on a variety of issues to shift costs that would be supported by taxes off the government budget.  Charity cases raise hospital costs, recovered from insurance companies, which pass the bill on to those buying coverage.  The insured, not the taxpayers, bear the burden.

The same way of looking at taxes comes from members of Congress representing low-tax states. They oppose federal tax deductions for state income taxes, claiming their states subsidize the higher tax states, like Maine.  It doesn’t matter that all states pay for disaster damage in Texas, Florida and California, not just the people in those states.

Opponents also see Medicaid expansion as allowing more people to become dependent on the program, ensuring higher government costs out into the future.  It’s linked to the broader question of so-called entitlement programs like Social Security and Medicare.  As more people become eligible for such programs, the budget increases.

If the referendum passes, it would place compassion above money, even though 90 percent of the costs would be borne by the federal government.  Expansion certainly would be better for the more than 70,000 people who would be affected.  But what about the taxpayer?

The vote may answer a question and ask a question.   It may reveal that, despite the calls of populists like Gov. LePage, voters want to help their neighbors.  At the same time, it raises the issue of when the federal government will stop sweeping entitlement reform under the carpet, and deal with it.

If there might be a single problem with Maine as a test for the country, it will be voter turnout.  Some voters say they will stay home because they don’t trust what either side says.  That’s easy to understand if a voter relies on television ads about the issue.  Some opposition ads are outright misinformation.

Another concern causing voters to consider skipping the referendum is that assistance programs like Medicaid produce cheaters.  People resent assistance programs when they can see a neighbor ripping off the government.  Yet not a word has been said about what will be done to combat cheating if Medicaid expansion passes.

Maine could overcome these concerns and serve as a good test of populism’s anti-government appeal.  The state is usually first or second nationally in election turnout.  With the eyes of the country and Congress on the state, Maine could provide a forecast of populism’s effect in the 2018 elections, but only if it has a good turnout.

All we have to do is vote on November 7.

Gordon L. Weil

About Gordon L. Weil

Gordon L. Weil formerly wrote for the Washington Post and other newspapers, served on the U.S. Senate and EU staffs, headed Maine state agencies and was a Harpswell selectman.