Democrats Set to Win on Health Care

House Speaker Mark Eves and Senate President Justin Alfond

I’m often disappointed with the tactical and strategic moves of elected Democrats. Too often it seems like they’re much less able than Republicans to craft and stick to a simple message or policy plan based on fundamental values and publicly repeat, strengthen and reinforce it over time. The current issue of hospital payments and health care expansion, however, looks set to be different.

Say what you want about Governor LePage (and I do) he knows how to push forward an agenda. His “pay our debts” mantra around his liquor deal/hospital payments plan is a good example and even when he (frequently) goes off the rails, he usually does so in the process of reinforcing his worldview.

When he does something like comparing the Obama administration and the Affordable Care Act to the Nazi Gestapo, for instance, he may lose personal credibility (if he had any left) but he often succeeds in shifting the debate onto his turf and getting media stories like this one that allow him to air all his grievances and repeat his talking points.

It’s hard to compete with someone who has the bully pulpit of the Governor’s office, is willing to be a bit personally self-destructive in order to advance their message and is looking to rile up their base for another 3-way gubernatorial race rather than build broader consensus.

That’s why I was so glad to see Democrats’ brilliant move last week coupling LePage’s own hospital payment plan with accepting federal money to expand health coverage. They’ve claimed the high ground and put LePage in a spot where his own reckless energy will work against him.

First of all, the plan is simple and makes good policy sense as the issues are already intrinsically linked. Taking the federal funds for expansion will also increase the match rate for certain populations already covered by MaineCare. As even the conservative Heritage Foundation has noted, this will save Maine $690 million dollars over the next 10 years. Much of that will be going to hospitals and can prevent future debt from accruing so we aren’t in the same place again.

It also helps to address two other major problems that are currently plaguing hospitals. Over the past six months, Maine’s health care institutions have seen a decrease in patient volumes and an increase in uncompensated care for those without health insurance. It’s hitting their budgets hard. Expanding coverage will mean fewer people putting off treatment (and an immediate rush to get care for conditions they’ve already been suffering) and more people whose care is paid for through MaineCare rather than written off as charity or bad debt.

In short, the Democrats’ plan treats the symptoms as well as the underlying disease. That’s a much more compelling case for linking two policies than could be made for (simply as a for-instance) coupling hospital debt payments with the state liquor contract.

This is, of course, in addition to the fact that the health care expansion will save Maine money, cover 69,500 more Mainers, and save lives, all at no extra cost to the state. 68% of Mainers support accepting the federal funds and a number of Tea Party governors across the country have already embraced them.

Secondly, passing this package puts LePage in a box that no amount of yelling will get him out of. He has made paying the hospital debt a centerpiece of his agenda and expended a great deal of political capital (and even dark money) to make it happen. If he doesn’t get it done the way he wants, he could look weak going into 2014.

LePage’s usual recourse of inflammatory public statements won’t work here. Before when he attacked on this issue, he was met with a nuanced response from Democrats that didn’t match the simplicity and ferocity of LePage’s message: “We also want to pay back the hospitals, but we have certain policy issues with this plan, we have to go through the normal legislative process and there may be some better alternatives.”

Now, however, the message will be straightforward: “We passed your plan exactly as you wanted. Why haven’t you paid the hospitals and why are you denying health care to Maine people?”

It puts the onus on the LePage and shifts the conversation to an issue that’s central to Democratic values and has wide public support.

Recognizing this, most of Maine’s major daily newspapers have now editorialized that LePage should essentially take the deal and expand coverage. The Bangor Daily News even gave him some pointers on how to appease the Tea Party:

“The Democrats’ bill may give LePage the opportunity to expand Medicaid and simultaneously appease his base. He can say Democrats forced the issue, and he took the high road to pay the hospitals. Or, he could finally come around to Medicaid expansion, as other Republican governors have done, and recognize that he would be supporting the hospitals by expanding Medicaid.”

Third, time won’t be kind to LePage. The longer he delays after the Legislature has passed this plan, the weaker his position becomes. No longer can he reasonably claim Democrats are holding up the payments (although I’m sure he’ll still try). Instead, he gets tagged as the obstructionist.

LePage’s fiscal position also erodes with time. As the budget looms larger, the liquor contract money he’s depending on to make his version of the plan work will look more and more enticing to cash-strapped Legislators of both parties who are trying to plug the budget hole. Once it’s up against all the other competing interests of the budget, including LePage’s revenue sharing, education and health care cuts, hospital debt may not seem like the most pressing priority.

In addition, a delay gives strength to LePage’s potential political challengers. Congressman Mike Michaud, who is considering a gubernatorial run, has already highlighted his own support for accepting the federal health care funds. A high-profile showdown over the issue between LePage and legislative Democrats makes the perfect case for his candidacy.

Fourth, this is likely the only way to actually pass the health care expansion. As LePage showed with his hyperbolic reaction to this proposal (calling it “criminal” and “a sin”) he was never really considering accepting the federal funds. Attaching them to his major legislative priority could change the equation, secure the funding and save peoples’ lives.

To make this strategy work, Democrats will need to do two things: stick together and get their message to the public.

While Democrats can’t always be as unified with each other as the Governor is with himself, on this issue maintaining unity shouldn’t be too much of a problem. Accepting the federal health care funds and expanding care is an issue that’s at the core of their Party’s values and on which nearly all Democrats (and quite a few Republicans) agree.

The challenge of getting their message out there is the greater. In case you haven’t noticed, there are a few other things going on in Augusta at the moment that demand attention and legislative leaders don’t get the kind of automatic coverage that LePage does for his pronouncements (in large part because they, rightly, won’t use the kind of inflammatory language that he is willing to employ). But the simplicity of this issue and the inherent conflict with the Governor makes things easier. All they need to do is continue to repeat their message and prod LePage for action. If he doesn’t accede, then the delay itself begins to become the story. I imagine they’ll also appreciate having such a straightforward, values-based issue to talk about as the budget negotiations get more and more complex.

It’s encouraging to see the reversal here. Where before LePage’s rhetoric and pressure from hospitals had put Democrats on the defensive, they’re now in a win-win situation. If LePage gives in right away, the hospitals get paid (although not quite in the way Democrats might have wanted) and 69,500 people get health care. If he doesn’t, then they can take a political stand for a straightforward and popular policy where they have the high ground and LePage’s position will weaken the longer he delays.

Mike Tipping

About Mike Tipping

Mike writes about Maine politics and policy with a focus on analysis and explanation. He works at the Maine People's Alliance and Maine People's Resource Center, writes a political column for the Portland Press Herald