Lobbying the feds on a Medicaid expansion plan may not make much difference

Good morning from Augusta. Since the state submitted a court-ordered Medicaid expansion plan to the federal government along with a letter from Gov. Paul LePage saying it should be rejected, top Maine Democrats have written to argue that it should be accepted.

While voters backed expansion in 2017, the Republican governor has blocked startup funding for the law. Maine’s high court ordered the state to file an expansion plan last month, but the federal review comes as legal questions on implementation still sit before a lower-court judge.

Diane Rowland, the executive vice president at the nonpartisan Kaiser Family Foundation, said on Wednesday that it puts Maine in “uncharted waters” on expansion, adding that it isn’t the Centers for Medicare and Medicaid Services’ role to reject plans conforming to the federal Affordable Care Act. But questions about how Maine will pay its share could lead to delays.

Most of the Medicaid expansion debate between states and the federal government has focused on waivers, but Maine is officially asking to follow the law. Federal law allows CMS to let states waive portions of Medicaid provisions, which allows for state-by-state experimentation with certain policy ideas. When it comes to coverage, this cuts both ways.

During the administration of former President Barack Obama, Republican states used this to expand Medicaid under pared-down provisions, such as with premium payments and elimination of retroactive eligibility, according to Health Affairs. The administration of President Donald Trump has allowed four states to extend work requirements to most regular Medicaid recipients.

Maine is one of seven states with a pending waiver to do that. However, this lies mostly outside the debate over expansion. LePage has argued that the state can’t expand Medicaid without dedicated funding, while advocates have said state surpluses can be used.

Those dueling reasons are why LePage sent a letter to CMS — copying Trump and Vice President Mike Pence — saying it should reject the state plan. Democrats — including U.S. Rep. Chellie Pingree of Maine’s 1st District and House Speaker Sara Gideon of Freeport — countered with letter to CMS urging it to approve the plan.

But the state plan officially says that Maine will adhere to the letter of federal law on Medicaid expansion. Rowland said that although an analysis of whether the state can pay for its expansion share could be reviewed under a waiver, it’s “just not part of the process” here.

“I think the fact that this is not a waiver but a State Plan Amendment,” she said, “means it should be a just straightforward, ‘Is what the state’s planning to do consistent with the federal statute? If so, proceed.’”

That doesn’t mean coverage will come quickly. However, Rowland noted she had been talking from “a policy perspective” and “there’s always a political perspective.” The Trump administration could delay a decision by asking questions about the finances, for example.

The voter-approved law pegged coverage to begin in July, but that deadline has long passed and there would likely be a lag as coverage ramps up after approval. With those constitutional questions about Maine’s budget process still sitting in court, it’s unlikely that this dispute ends soon — and perhaps not by the time LePage leaves office in early January.

Another group is spending $1 million against Poliquin

It continues a deluge of at least $8 million in committed outside money in Maine’s nationally targeted 2nd District. U.S. Rep. Bruce Poliquin, a Republican, is being targeted in a new ad released by Patients for Affordable Drugs, a group led by Ben Wakana, a Maine native and former Affordable Care Act spokesman in the Obama administration, for his support of Republicans’ tax overhaul last year. The group says it’s spending more than $1 million on TV, radio and digital ads.

Poliquin has had a steep fundraising lead on his chief opponent, Assistant Maine House Majority Leader Jared Golden, D-Lewiston, but outside money has been helping Golden effectively close the gap. More than $1.2 million in outside spending has been reported to the Federal Election Commission to boost Golden already, compared to just $125,000 for Poliquin.

Those amounts don’t include that new $1 million — though the ad doesn’t mention Poliquin’s election — or existing ad reservations from other groups. The Congressional Leadership Fund, a Republican super PAC, has reserved $2.8 million in ad time this fall and a pro-Trump group has booked $1 million. House Majority PAC, a Democratic super PAC, had reserved $2.2 million in time ahead of more spending announced this week.

That $8 million total is a back-of-the-envelope figure, with more likely having been committed already and more to come. The race looks more than primed to exceed the $10.2 million in outside money as tallied by the Center for Responsive Politics in Poliquin’s 2016 race against Democrat Emily Cain.

Today in A-town

The Legislature is adjourned, but its leaders are still meeting. The Legislative Council — the 10-member leadership group that essentially functions as a town council for the capital complex — is scheduled to hold one of its last meetings today.

As would be expected, the agenda is pretty sparse. The most interesting item is likely to be discussion of a draft policy to set clearer guidelines for political activity at the State House. Spurred by a request to light up the dome with blue lights to mark Israel’s 70th birthday, it will address projecting images onto the building, as well as sign placement and other political activities. You can listen to that discussion here, starting at 1:30 p.m.

Spoiler: The current dome lighting system is not set up to make it possible to easily change the color of the lights.

Reading list

  • A Maine senator who could be the deciding vote said the woman who accused a Supreme Court nominee of sexually assaulting her should share details with the Senate. On Wednesday, Sen. Susan Collins, a Maine Republican, told WVOM that Christine Blasey Ford should testify before the Senate Judiciary Committee about her allegations that Supreme Court nominee Brett Kavanaugh sexually assaulted her in the early 1980s, but Ford wants an FBI investigation first. Collins said an FBI investigation now would reverse the normal order of confirmation proceedings and that the FBI normally doesn’t pursue allegations involving someone who was a minor at the time. Collins is one of two Republican senators who has withheld public support for Kavanaugh, although her recent statements have caused concern among abortion-rights advocates who fear Kavanaugh would pave the way for the conservative bloc on the high court to reverse Roe v. Wade, the 1973 ruling that legalized abortion.
  • Maine won’t renew the teaching credential of a former state lawmaker who has been accused of sexual misconduct with students. In making the decision on former Rep. Dillon Bates, the Maine Department of Education cited a state rule allowing it to revoke certifications in cases of “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature.” A lawyer for Bates, who has denied anonymously sourced allegations of misconduct against students published in The Bollard, said his client withdrew an appeal of the decision because he will not be able to work in schools “in the near future given the media coverage of the false allegations made against him.”
  • As a delayed response to a 2015 law, Maine schools are implementing policies designed to prevent sexual abuse of young children. Prompted by the law that required a new model to be implemented by July 1, 2016, the Department of Education and the Maine Coalition Against Sexual Assault have created a model policy for school administrators to adopt this year. The policy also provides pre-kindergarten through grade 5 students with age-appropriate child sexual abuse prevention education.
  • If you have to die, you might as well die high. That seems to be the premise of a Maine lobster shack owner who has been exposing lobsters to marijuana smoke before dropping them into pots of boiling water. Charlotte Gill, owner of Charlotte’s Legendary Lobster Pound in the Southwest Harbor village of Seawall, has treated lobster by blowing marijuana smoke into a plastic box with a lobster in it before the lobster goes in the cooking pot. She said killing the lobster by stabbing it through its head or by electrocuting it can be quicker, but also can be cruel if not done correctly. Gill, a licensed medical marijuana caregiver, said Wednesday that the practice is “kinder” for the lobster, which in addition to being boiled alive has to endure a stressful environment of being kept in a crowded tank with other lobsters before it is killed.

What you can’t say in school

A Pennsylvania lawmaker wants to ban all talk of politics and government in school. Republican Will Tallman, who is not seeking re-election, has proposed a “teacher code of ethics” that would bar educators from discussing — and, more importantly, criticizing — elected leaders and government in public schools.

The Morning Call reports that “teachers could not discuss enacted or pending legislation, regulations, executive orders or court cases involving any level or branch of government. They could not talk about activities ‘that hamper or impede’ law enforcement actions or military recruiters on campus.”

While Tallman’s proposal raises constitutional concerns, it also sparks thoughts of other forms of speech that have not been OK in the classroom.

When I was a student in the 1960s, prayer in the classroom became a no-no. I remember my second-grade teacher asking me what I was doing as I seemed to be tearing up during the “moment of silence.” I had smashed the top of my desk down upon my fingers and was trying not to cry, but I didn’t want the teacher to think I was a wimp, so I told her I was “saying my prayers.”

She looked alarmed and said “don’t tell me that” as she scuttled away quickly.

When I was a special education teacher during the 1980s, prayer rarely factored into the equation. We generally focused on behavior — getting through the school day without a brawl — and encouraged open dialogue. Profanity and saying nasty things about a classmate’s mother were the only forms of prohibited speech in my classroom.

I had a sign that read, “If you swear, you write” posted prominently in the front of the room. Anyone who violated that guideline had to complete worksheets on cursive handwriting before they could escape my room to blow off steam — and probably swear and say bad things about other people’s mothers — at recess.

After the initial testing period in which some students ended up with an inch-deep pile of worksheets, it was surprisingly effective, although none of us got much better at signing our names. But it did tend to make our conversations more upbeat. Here’s your soundtrack. — Robert Long

Programming note

The Daily Brief will take Friday off to allow staff to devote full attention to preparing for the autumn equinox. Also, Mike is heading to Montreal to see Paul McCartney. We will return on Monday, Sept. 24. Here’s your soundtrack.

Today’s Daily Brief was written by Michael Shepherd and Robert Long. If you’re reading this on the BDN’s website or were forwarded it, click here to receive Maine’s leading newsletter on state politics via email on weekday mornings. Click here to subscribe to the BDN.

To reach us, do not reply directly to this newsletter, but email us directly at mshepherd@bangordailynews.com or rlong@bangordailynews.com.

Michael Shepherd

About Michael Shepherd

Michael Shepherd joined the Bangor Daily News in 2015 after covering state, federal and local issues for the Kennebec Journal for three years. He's a Hallowell native who now lives in Gardiner. He graduated from the University of Maine in 2012 and is a graduate student at the University of Southern Maine's Muskie School of Public Service.