How the Koch brothers are killing Medicaid expansion in Maine

In December of last year, Maine Representative Brian Duprey (R-Hampden) posted a photo to Facebook from a presentation at the American Legislative Exchange Council (ALEC) conference he was attending Washington D.C. ALEC is a secretive organization that serves as a pipeline into state legislatures for corporate-backed policies.

“Watching my good friend Tarren Bragdon moderate a panel on Obamacare and Medicaid expansion,” Duprey captioned the photo, which shows Bragdon behind an ALEC-branded podium. The post was “liked” by Maine House Minority Leader Ken Fredette.

Fredette, Duprey, and most of their fellow Republicans in the Maine House and Senate have so far been unwilling to join Democrats in sufficient numbers to overcome a gubernatorial veto and accept federal health care funding made available through the Affordable Care Act to expand health care coverage in Maine. Enough of them have stuck with Governor Paul LePage despite the popularity of the issue and its economic, budgetary and health care benefits that even a compromise bill advanced by Republican Senator Roger Katz faces an uncertain legislative future following its likely veto by LePage today.

Why is this the case, when Republicans have been willing to ignore the increasingly-marginalized LePage on other issues, including rejecting his budget recommendations for two years in a row? The Facebook post by Duprey, which may seem at first to be just one more inconsequential social media interaction, actually points us toward the answer to that question.

Bragdon, a former Maine legislator, former head of the conservative Maine Heritage Policy Center (MHPC) and former co-chair of LePage’s transition team, now heads a Florida-based organization called the Foundation for Government Accountability (FGA). His office in Naples is a nexus in a national network of conservative groups and causes funded by large corporations and some of the wealthiest conservative donors in the country, including billionaire oil magnates and arch-libertarians Charles and David Koch. The Kochs and their close allies are responsible for creating and underwriting much of the current right-wing establishment. (For instance, they sit on ALEC’s corporate board and are likely responsible for a significant amount of its funding.) They’ve spent millions fighting health care reform and the debate over Medicaid expansion in Maine is a convenient battlefield in their wider war against the Affordable Care Act and any government involvement in ensuring access to health coverage.

FGA doesn’t release information about its donors, but some hints about their financing have made it into the public domain. In 2012 (the last year for which records are available), tax documents filed by other organizations indicate that FGA received $213,500 from Donors Trust, a foundation created to allow conservative donors, including the Koch brothers, to give anonymously to various causes. FGA received $108,150 from the State Policy Network (SPN), an ALEC-founded and Koch-funded umbrella group for state-level conservative organizations of which both FGA and MHPC are affiliates. They also received $25,000 from the Atlas Economic Research Foundation, another group with close ties to the Kochs.

It’s the backing of these powerful national groups that has likely made the difference in allowing LePage to secure critical Republican votes in favor of his policy of refusing federal health care funding and denying coverage for 70,000 Mainers.

In pursuit of this goal, LePage and his national allies have engaged in a remarkably cynical campaign which has seen the large-scale rejection of political and policy reality and the creation and dissemination of new “facts” that more comfortably fit with their ideology. As the Bangor Daily News recently editorialized, it’s like something “straight out of 1984.”

One area where this is particularly clear is public opinion research. A solid majority of Americans and Mainers support accepting federal funding and expanding health care coverage through Medicaid. It depends how you ask the question, but the Kaiser Family Foundation tracking poll (the gold standard for public opinion research on health care) recently found 74% support nationally for state health care expansion (making it one of the most broadly popular aspects of Obamacare). A Public Policy Polling survey of Maine voters released yesterday found 57% in favor and only 35% opposed (even less than the 37% of voters who express support for Governor LePage). A December poll by MPRC (which I’m proud to say has the best record for accuracy of any Maine polling organization) of Maine House Districts with close results in the last election found 69% of likely voters in favor of accepting federal funds.

How can expansion opponents deal with this kind of public support? Apparently, by refusing to admit it exists and instead making up their own numbers. FGA and Americans for Prosperity (AFP) recently released the results of a Maine survey that used biased questions and outright lies (for instance claiming that one third of those eligible for expanded coverage were “former prison inmates” – an all-but mathematical impossibility given Maine’s lowest-in-the-nation incarceration rate) in order to claim that a plurality oppose expansion. The survey was so badly done that, based on the first reports, most experts I talked to assumed it was a push poll.

The poll also claims to break results down by age, gender and party affiliation even though respondents to the survey report that none of those questions were asked, hinting at a whole other level of polling malpractice.

The partnership between FGA and AFP on this shady operation is no coincidence. AFP was founded by the Koch brothers and David Koch served as its first chairman. These groups, along with SPN and ALEC, with which they’re both affiliated, are working hand in hand in states across the country to oppose Medicaid expansion and the Affordable Care Act. In Alaska, for instance, the Alaska Dispatch recently revealed that the two groups collaborated in the creation of an controversial website meant to trick Alaskans into not signing up for coverage through the health insurance exchange.

One of the more visible signs of FGA’s advocacy on this issue has been in-state speaking engagements by FGA Senior Fellow Christie Herrera, who has crisscrossed the country peddling opposition to state Medicaid expansions. Herrera also represents another link between FGA and the American Legislative exchange Council. Before her recent move to the Florida-based group, she was director of ALEC’s Health and Human Services Task Force and she still maintains a hand in the inner workings of the corporate-controlled policy incubator.

Last week the Wisconsin State Journal reported that a cache of documents obtained as a result of an open records lawsuit by the Center for Media and Democracy show that, while at FGA, Herrera actually wrote the anti-Medicaid expansion resolution that ALEC adopted last year. Emails from Herrera show that she convinced three state legislators in different states to introduce her motion as their own and wrote introductory remarks and talking points for them to use at ALEC’s 2013 Spring Task Force Summit.

Opponents of accepting federal health care funding have taken a similar approach to health care policy as they have to public opinion in Maine. With every independent study confirming that expansion will boost the state’s economy while saving lives, they needed some way to muddy the waters. Luckily, they had the perfect candidate to stir up the bottom: former Pennsylvania Department of Public Welfare Secretary Gary Alexander.

Herrera and Alexander at the American Enterprise Institute (video still)

Herrera and Alexander at the American Enterprise Institute

Alexander is no stranger to FGA and ALEC. In 2011, ALEC’s newsletter featured Alexander’s Medicaid privatization ideas as the #2 way to “push back against ObamaCare.” In 2012, Alexander and Herrera headlined an anti-Medicaid expansion panel discussion at the American Enterprise Institute. In 2013, Alexander joined Herrera for a conference call with FGA supporters.

“I thank you, Christie, and your great organization for organizing this,” said Alexander as they ended the call. “You guys are a tremendous repository for all of this information and I look forward to continuing to work with you as we solve the country’s most vexing problems.”

Later that year, Alexander was given a $925,000 no-bid contract by the LePage administration to review Maine’s public assistance and health care programs and write a “Medicaid expansion feasibility study.” Sam Adolphson, a former policy analyst for MHPC under Bragdon, was named as the Department of Health and Human Services’ program administrator for the study.

Alexander delivered exactly what expansion opponents were seeking and couldn’t find: a report claiming that accepting the federal funding would result in a net cost for the state. LePage and his allies trumpeted the findings when the report was released and have continued to do so, despite significant problems that have emerged concerning Alexander’s work. These include the fact that he ignored the broader economic impact of the federal funds, made strange assumptions such as that the state poverty rate will increase by more than 30% over the next ten years and even made a $575 million error in basic multiplication.

The Portland Press Herald called the report “shoddy” and “riddled with errors and ridiculous assumptions.” The Bangor Daily News deemed it a failure and “a political document disguised as impartial analysis created at taxpayers’ expense,” but within the bubble of the Republican caucus it has maintained some currency. Perhaps this is because its flawed findings have been continually touted by ideological allies like Bragdon, who returned to Maine to personally lobby Republican legislators on the bill.

Defective as it is, Alexander’s report may succeed in helping to convince that critical handful of on-the-fence GOP Representatives and Senators to stick with LePage.

Even with its flaws, the report has certainly been more successful than another aspect of the expansion opponent’s efforts: the attempt to organize on-the-ground opposition to accepting federal funds in Maine. This campaign has been led mostly by the Maine chapter of AFP (which commonly acts as the grassroots wing of the Koch-affiliated groups and has close ties to tea party organizations) and the Maine Heritage Policy Center.

Unlike the attempts to manufacture policy and public opinion arguments against expansion, the effort to build a grassroots opposition has been less well-coordinated. A recent AFP event in Augusta, for instance, was described as by the media as “lightly attended” and the highlight was apparently AFP-Maine head Carol Weston drawing a picture of Pacman, quite a contrast with the hundreds of expansion supporters who have rallied at the State House over the past few months and shared personal stories about the life and death consequences of a denial of care.

from MHPC Facebook page

from MHPC Facebook page

MHPC, once acknowledged as the state’s conservative powerhouse (before most of its staff left for FGA and the LePage administration), seems to have been significantly reduced in effectiveness. Their advocacy has mostly consisted of running online ads, posting anti-expansion articles to their fake news site, The Maine Wire, and uploading photos to Facebook with a hammer and sickle photoshopped into the word “Obamacare.”

None of this has been pretty, but in the end it might be enough.

If Governor LePage maintains just enough minority support to uphold his veto, these national networks of conservative organizations and activists will deserve much of the credit. They won’t, however, be the ones who have to bear the political consequences. No matter what their biased polling purports to show, the public is broadly supportive of expansion and progressives are already preparing to use any rejection of federal funding as a key issue in November’s House and Senate elections.

Democratic Gubernatorial candidate Congressman Mike Michaud has also made expansion a cornerstone of his campaign against LePage, repeatedly saying it’s the first issue he’ll address as Governor.

Maine Republicans shouldn’t be surprised if they face an electoral backlash this November. After all, the last time they followed Bragdon on a piece of health care policy they saw the same result. In 2011, legislation was hashed out in closed-door meetings between Bragdon, key GOP legislators and insurance company lobbyists that struck down consumer protections in Maine’s insurance market. MHPC experts told the Republican caucus that it would lower premiums, but the real result was immediate insurance rate hikes for small businesses all over the state, in some cases by triple-digit percentages. The rate hike bill, as it came to be known, ended up being one of the central issues Democrats used to win back control of the Maine House and Senate in 2012.

Perhaps Republicans think the the result of the current debate will be different. Maybe they believe the biased polls, or perhaps they think the deep-pocketed donors, including the Koch brothers, who have bankrolled this effort by ALEC, FGA and AFP will come to their electoral defense during the coming campaign.

Whatever the eventual legislative results or electoral consequences, what’s clear right now is that the worst kind of corporate, money-driven, right-wing politics have come to Maine in full force and that federally-funded health care coverage for 70,000 Mainers may be the latest casualty in a national, ideological crusade.

Don’t be fooled; the rejection of federal funding so far in Maine isn’t just the result of the stubborn intransigence of one tea party governor, it’s part of a well-funded, well-coordinated campaign to impose on all of us the political views of a wealthy, conservative few.

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