For hundreds of volunteers who collected signatures, held community meetings, knocked on doors, and shared their personal stories with lawmakers, the executive order signed by Governor Janet Mills on Jan. 3 to implement voter-approved Medicaid expansion was a cause for celebration, but for many of these grassroots advocates it is also just the first step in making sure all Mainers have access to health care.
“Having [Gov. Mills] sign this executive order on her first day, it’s like, finally, somebody is doing their job,” said Lynnea Hawkins, a single mother from Lewiston who collected signatures and led a team of volunteer canvassers who contacted voters in support of the 2017 referendum for Medicaid expansion.
After the initial excitement of winning the referendum, which was passed with 59 percent of the vote, (after Medicaid expansion had been passed five times in the legislature, only to be repeatedly vetoed by Governor Paul LePage) Hawkins and the other volunteers were angered by the LePage administration’s refusal to implement the voter-mandated expansion. Now, she says, “It’s a little bit vindication. It’s a little bit of a deep breath. I support Mills, but I am going to be watching to make sure she does what she says.”
Hawkins spent a year without any health insurance after losing Medicaid coverage when she found part-time work as an office administrator. The job did not come with benefits, and private insurance would have cut her paycheck in half, she said.
“It’s funny, you have to be completely out of the loop to get the care you need,” Hawkins said.
Medicaid expansion is designed to help some of those in Hawkins’ situation — earning too much to qualify for Medicaid, while making too little to afford private insurance. With Mills’ executive order, 70,000 Mainers within 138 percent of the federal poverty line, an annual income of about $34,600 for a family of four, will soon be covered through MaineCare, the state’s Medicaid program.
The influx of federal dollars into the state is estimated to create 5,980 new jobs and $684 million in economic activity, according to the Maine Center for Economic Policy.
Hawkins says she listened to many difficult stories on the doorsteps of Lewiston residents in the lead up to the referendum vote, but she was most struck by a single mother she met, Donna Wall, who cares for three autistic children and was struggling to pay $60,000 in medical debt after slipping and breaking her ankle while delivering newspapers early one winter morning. Wall, she said, was motivated to get involved and put in many hours canvassing with Hawkins’ small team of volunteers. “There are stories like hers all over this state,” Hawkins said.
Kara Auclair and her husband knocked on doors in Portland and South Portland to encourage residents to vote in favor of Medicaid expansion. Auclair vividly remembers one of the first conversations she had while collecting signatures, which was with a woman who told her that she was uninsured, then broke into tears.
“I just remember her emotion and remembering feeling that this isn’t fair. It’s not right,” Auclair said. “I just remember being in that moment of despair with her.”
After working on the grassroots campaign in support of the expansion referendum, Auclair, who works at the Volunteer Lawyers Project, went on to manage the successful election campaign of South Portland city council member Deqa Dhalac. She said she was excited by the news of the executive order finally clearing the way for expansion that she and her husband worked so many months for.
“It’s happiness, but there is also frustration that it has taken this long,” Auclair said. “People said they wanted this more than a year ago.”
A win against political obstruction
In the spring of 2018, after former Governor Paul LePaul refused to file an application for the federal Medicaid funds to begin expanding the state’s program, a legal team brought together by Maine Equal Justice filed suit against the administration. State courts ruled in favor of the group’s argument that LePage could not ignore the will of the voters and undermine the state’s referendum process. Despite the ruling, the administration continued to appeal up until LePage’s last days in office.
“Clearly, we’re celebrating,” said Kate Brennan, an organizer with Maine Equal Justice. “We’re happy and relieved and celebrating the years of organizing that went into this win. All the organizing that brought together those impacted by the state’s health care crisis, the dozens of social justice organizations, the health care advocates, the policymakers, all those people working together to get this done. A lot of blood, sweat and tears.”
While the executive order is a crucial step, Brennan says that their advocacy will continue in order to ensure that expansion is a success. As a result of their lawsuit, Maine Equal Justice’s legal team ensured the state sought funding for expansion back to July 2, when the law took effect. This gives the Maine Department of Health and Human Services the ability to potentially grant retroactive coverage to some applicants. Applications that have already been submitted are now being reviewed. Brennan says they will be working with the Mills administration, new DHHS Commissioner Jeanne Lambrew, and other health care advocates to make sure the Mainers who are eligible will be contacted and made aware of their right to coverage.
Ensuring that expansion is successful is critical to delivering greater access to health care, Brennan said.
“I think people in Maine are so tired of having to get our health care through GoFundMes and gas station fundraisers. Tired of people we love getting sicker from preventable illnesses just because we couldn’t afford a doctor. People are ready for bold solutions,” Brennan said. “Medicaid expansion is a critical step towards universal coverage, and that’s what we hope to see in the long term.”
Increasing support for universal health care
Mills and her challengers in the Democratic primary all campaigned on a promise to implement Medicaid expansion. But now, with mounting support for a universal health care system, many of the grassroots organizers who pushed for expansion in 2017 say it is time to begin organizing for policies such as “Medicare for All.”
“I would really like to see a push for a universal health care system where everybody is covered,” Hawkins said. “I don’t think it should be about how many hours a week you work, how much you earn.”
“The fight’s not over,” Auclair said. “We need a movement that includes many different stakeholders. All the different groups that understand the different needs of different vulnerable groups need to be brought to the table.”
Grassroots organizations like Maine AllCare are pushing state lawmakers to examine the possibility of a single-payer system which could be implemented at the state level. State Rep. Mike Sylvester (D-Portland) has already introduced a single-payer bill for the new legislative session in Augusta.
A first step in that direction might be a policy proposed by Senate President Troy Jackson to allow more Mainers to buy in to health care coverage through Medicaid. Jackson is also submitting legislation to allow the reimportation of prescription drugs.
On election day last November, nearly 200 Maine AllCare volunteers collected cards signed by voters outside the polls saying they supported universal health care. According to Maine AllCare director Phil Bailey, the group collected approximately 15,000 signed cards in one day.
“Before election day, some of the volunteers said, ‘Oh, my town is very conservative — I don’t think I will get very many.’ Then they would come back with a big stack of cards,” Bailey said. “They’d say, ‘I know these people, they voted for Trump.’ It’s amazing how across the board it is.”
He added, “Mainers want things to be simple, understandable and effective. If everybody is in, and everybody is covered. Mainers are good with that.”
(Top photo: Volunteer Kathy Phelps speaks in Augusta about about the need for affordable health care. | Mainers for Health Care)
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