President Obama's healthcare law expanded Medicaid to everyone at or below 133 percent of the federal poverty line, beginning in 2014. The federal government will initially cover all of the additional costs.
The law also included a "maintenance of effort" (MOE) provision, barring states from cutting their eligibility ahead of 2014, when the federally funded expansion would take place.
The Supreme Court said states must have the option to opt out of the Medicaid expansion in 2014. LePage said he believes the ruling also gets him off the hook for the MOE.
Pingree, who had considered a bid for the seat being vacated by Sen. Olympia Snowe (R-Maine), asked the Health and Human Services Department on Tuesday to say that LePage is still bound by the MOE.
"It is clear to me that the governor’s proposed elimination of Medicaid coverage would not only adversely affect the health and well-being of Maine residents and upset Maine’s local economies; it would also be in direct violation of the MOE requirement, even in the wake of the Supreme Court’s ruling," Pingree said in a letter to HHS Secretary Kathleen Sebelius.
As Pingree noted in her letter, the Supreme Court's decision does not mention the MOE provision, much less explicitly strike it down.
But the requirement is structured the same way as the unconstitutional expansion. Both the expansion and the MOE provisions in the healthcare law say states have to participate or give up all of their Medicaid funding. The court said that threat was "coercive" in the context of the expansion.
Pingree said the court's decision on the Medicaid expansion doesn't affect the MOE. The court said Congress could not withhold existing funds over a new program — but the MOE is not a new program, Pingree argued. It's a requirement to continue policies that were already in effect.
"As you continue to examine the potential implications of the Supreme Court’s decision, and develop guidance for states on the current and future implementation of the ACA, I strongly hope that you will reaffirm your commitment to the MOE requirement," Pingree said in her letter to Sebelius.
About 27,000 Maine residents would lose their coverage if the state can escape the MOE requirements, Pingree said. LePage's cuts would hit certain people with disabilities as well as 19 and 20 year-olds and parents with incomes between 100 percent and 133 percent of the poverty level.