ObamaCare (still) lives
June 5, 2018

On Monday, a Maine Superior Court judge ordered Gov. Paul LePage (R) to move forward on a Medicaid expansion law approved by nearly 60 percent of voters in 2017, saying his administration's "complete failure to act" by the April 3 deadline "cannot be considered substantial compliance" with the new law. LePage, who had vetoed five bills to expand Medicaid in five years, argued that he would not enact the voter-approved law unless the legislature appropriated money for it without raising taxes. He also complained that the Medicaid expansion, allowed under the Affordable Care Act and mostly financed by the federal government, was a form of welfare.

Justice Michaela Murphy said the law was "clear and unambiguous" that LePage's administration had to send the federal government a plan to accept the Medicaid expansion by April 3, allowing lower-income residents to obtain coverage by July 2, and she gave him until June 11 to send the paperwork to Washington. A LePage spokeswoman said the governor's office is reviewing the ruling and did not say if he will appeal to the Maine Supreme Court. "Maine voters did not make a request at the ballot, they passed a law, and laws are not optional," said Robyn Merrill at Maine Equal Justice Partners, the lead plaintiff suing LePage. "Today's ruling is good news for more than 70,000 Mainers who the law says can sign up for health care on July 2."

Last week, Virginia lawmakers approved Medicaid expansion for 400,000 residents, and Utah voters will consider expanding the program in November, as might voters in Idaho and Nebraska. The Affordable Care Act's Medicaid expansion extends coverage to citizens with income up to 138 percent of the poverty level; the federal government picks up the entire tab for the new enrollees for three years, then at least 90 percent after that. Seventeen states have declined to take the federal government up on the offer. Maine was the first state to expand Medicaid by referendum. Peter Weber

March 9, 2018

On Thursday, the Centers for Medicare and Medicaid Services (CMS) shot down Idaho's bid to allow lower-cost, lower-coverage health insurance plans that don't comply with the Affordable Care Act. ObamaCare "remains the law, and we have a duty to enforce and uphold the law," CMS Administrator Seema Verma said in a letter to Idaho Gov. C.L. "Butch" Otter (R) and the head of the state's insurance department. Verma, who pushed for repealing ObamaCare, did not seem enthusiastic about denying Idaho's bid, and she said that "with certain modifications," its proposal might pass muster.

In January, Otter signed an executive order paving the way for cheaper health plans that allow higher premiums for people with pre-existing conditions, cap the amount of coverage allowed, and exclude the suite of "essential health benefits" required under the ACA. Blue Cross of Idaho had proposed five such plans to be launched in April, but Veema said if Idaho fails to "substantially enforce" ObamaCare, the federal government will step in as "primary enforcer." Idaho said "dozens" of other red states had expressed interest in its plan to flout ObamaCare, though none has followed through.

ObamaCare supporters were pleased but not overly impressed by the CMS move. "The Trump administration is talking out of both sides of their mouth," said Sen. Ron Wyden (D-Ore.). "While they claim to be upholding the law, they are explicitly inviting Idaho and other states to sell short-term, junk insurance — the exact opposite of the protections put in place by the Affordable Care Act." Peter Weber

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