text: After President Trump and Republicans in Congress spent much of the year trying to repeal the health law and cut spending on Medicaid, a half-century-old entitlement program that covers one in five Americans, the pro-expansion side in Maine is hoping to benefit from energized public support for it. 
   
   Turnout may be the biggest challenge for the advocacy groups leading the effort. There are no national or statewide races here to drive people to the polls this year. And Mr. LePage’s stance on government safety net programs appeals to many voters in the state’s more rural regions. He derides Medicaid expansion as “pure welfare” that would burden the state’s taxpayers. 
   
   Senator Susan Collins of Maine, one of the few Republicans who firmly opposed the Obamacare repeal bills, is not taking a position on the ballot measure — she never does on referendums, according to her staff. But leaders of the campaign are hoping her outspoken support for Medicaid during the repeal battles will help. 
   
   About 80,000 additional Mainers would become eligible for the program if the ballot measure were to succeed, according to the nonpartisan Maine Office of Program and Fiscal Review, although those with income above the poverty line currently qualify for subsidized coverage through the Obamacare marketplace. In all, more than 2.5 million poor uninsured adults across the country would gain access to Medicaid if the holdout states expanded the program, joining about 11 million who have already signed up under the law. ||||| Gov. Paul LePage attacked Maine’s hospitals on Friday for supporting the Medicaid expansion referendum on the Nov. 7 ballot, which if approved would provide free health care to about 70,000 low-income Mainers. 
   
   LePage aimed criticism in particular at Maine Med president and CEO Richard Petersen, who expressed support for the ballot question in a hospital newsletter. 
   
   “It’s obvious the CEO of Maine Med and other hospitals do not care about taking resources away from our most vulnerable Mainers – including our elderly and intellectually and physically disabled people – just so they can give free, taxpayer-funded healthcare to adults who should be working and contributing to the cost of their own health insurance,” LePage said. 
   
   Maine Medical Center responded in a statement provided to the Portland Press Herald by hospital spokeswoman Caroline Cornish. 
   
   “While we do not share his point of view, we understand that the governor has had a consistent position regarding Medicaid expansion, as has our organization. We hope Maine people will take the time to learn about this important issue and vote on Nov. 7,” the statement said. 
   
   Medicaid expansion would result in a number of benefits to Maine, supporters say, such as making the population healthier and more likely to access preventive care, creating 4,000 jobs in the health care industry, and driving down the uninsured rate. Maine’s uninsured rate was 9.1 percent in 2016, according to Gallup polling. 
   
   LePage has vetoed five attempts by the Legislature to approve Medicaid expansion, but would not be able to do so if voters approve the referendum on Nov. 7, a consideration that spurred the effort by an advocacy group to put the measure on the ballot. 
   
   LePage remains a steadfast expansion opponent, and he argued that hospitals would benefit financially “on the backs” of Maine taxpayers. About 265,000 Mainers currently have Medicaid. 
   
   “Since hospitals are nonprofit organizations, they don’t have to pay taxes on much of their vast real estate holdings. Mainers do not have that luxury – in addition to paying their own high premiums and deductibles, they will have to pay to give ‘free’ healthcare to adults who should be working,” LePage said in a statement. “As I always say, ‘free’ is very expensive to somebody. If hospital CEOs have their way, that somebody would be Maine taxpayers.” 
   
   LePage’s relationship with Maine hospitals has soured considerably since 2013, when he fought a successful battle with the Legislature to pay off $105 million in unpaid MaineCare reimbursements to hospitals. The money came from a bond financed with state revenues from a new wholesale liquor contract. LePage characterized the payoff as an investment in jobs because of the capital it would provide to hospitals, and he was so adamant about making the reimbursement that he threatened to veto every bill that landed on his desk until lawmakers agreed. 
   
   In his statement blasting hospitals on Friday, LePage repeated his frequent contention that Medicaid expansion would cost Maine taxpayers $500 million over five years, or $100 million per year. 
   
   But that’s incorrect, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. 
   
   State taxpayers would be on the hook for $54 million per year, but Maine would receive $525 million per year from the federal government for Medicaid expansion, the office said. 
   
   The federal government is paying 90 percent or more of the cost of covering the expansion population. Maine is one of 19 states – and the only one in New England – that hasn’t approved Medicaid expansion. Instead, the state has reduced Medicaid eligibility since LePage took office in 2011, cutting off Medicaid for childless adults and tightening eligibility for parents. 
   
   Ann Woloson, public policy director for Maine Equal Justice Partners, the group behind Medicaid expansion, said many rural hospitals are struggling financially in part because of the free health care they must provide to the uninsured. Medicaid expansion would put these hospitals on more solid financial footing, Woloson said. 
   
   “These hospitals are in danger of closing their doors, and Medicaid expansion would not only help with that, but also help these hospitals with workforce shortages to attract doctors and nurses to work there,” she said. 
   
   Jeff Austin, vice president of government affairs and communication for the Maine Hospital Association, said that hospitals have “supported expansion for four years and continue to do so.” 
   
   “Hospitals see tens of thousands of patients every year who don’t have insurance and need care,” Austin said. “The question is about what is the smartest way to take care of that population and we believe the answer is Medicaid expansion.” 
   
   Austin declined to get into a point-by-point refutation of LePage’s statements against the hospitals. 
   
   LePage framed expansion as a move that would take money away from others, saying “hospitals are only concerned with their pocketbooks, and they don’t care about the hardships it will cause for taxpayers, the elderly and the disabled.” 
   
   Medicaid expansion would not take away care for the elderly and disabled, expansion advocates say. States have some leeway on how to spend Medicaid money, they said, and expanding Medicaid would not hamper programs for the elderly or intellectually disabled. 
   
   Joe Lawlor can be contacted at 791-6376 or at: 
   
   [email protected] 
   
   Twitter: @joelawlorph 
   
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target: – On Nov. 7, Maine will take an unprecedented step for a state when it allows residents to vote on expanding Medicaid under the Affordable Care Act, the New York Times reports. Maine is one of 19 states where Republicans have blocked Medicaid expansion available under the ACA. The Maine legislature has voted repeatedly to expand Medicaid only to have Gov. Paul LePage veto expansion five times. However, if expansion is approved by voters through a referendum next month, LePage would be unable to veto it. If the referendum passes, approximately 80,000 more Maine residents making up to 138% of the poverty level will be eligible for Medicaid. In addition to decreasing the number of uninsured Maine residents, supporters of the referendum say it will add jobs and help rural hospitals stay open. LePage, while attacking Maine hospitals for their support of the referendum on Friday, said it would take "resources away from our most vulnerable Mainers" to "give free taxpayer-funded healthcare to adults who should be working and contributing," the Press Herald reports. Under the ACA, at least 90% of Medicaid expansion costs would be covered by the federal government. The other 18 states where Medicaid expansion has been blocked are carefully watching what happens in Maine. It's estimated more than 2.5 million Americans would gain access to health care if all 19 holdout states allowed Medicaid expansion.