When the U.S. Supreme Court found the Affordable Care Act constitutional, we knew there’d be an explosion from Gov. Paul LePage. Like most Republicans governors, he was so sure the court would strike down the law that the scene at 10 a.m. that Thursday can only be imagined.

The explosion arrived with LePage’s weekly radio address, which he himself edited to refer to the IRS as the “new Gestapo” because of its role in implementing the ACA. The remark spread nationwide as the latest among LePage’s intentionally offensive remarks, which have also targeted the NAACP, environmentalists, and state employees, among others. Adding Jews, the real Gestapo’s primary targets, is disturbing, as is LePage’s trademark refusal to apologize.

The offenders grew to include House Speaker Robert Nutting, who became the governor’s enabler by referring to the controversy as “much ado about nothing,” and saying that politicians invoke the word “Gestapo” all the time. No they don’t, Mr. Speaker. Not in Maine.

But the top Republicans’ obtuseness obscured a larger point: What LePage said about the health care statute that’s now the law of the land was wildly inaccurate.

Like fellow GOP governors saving face, LePage pounced upon Chief Justice John Roberts’ characterization of the individual mandate penalty as a tax. To some degree, your tax is my fee, but there’s little evidence that the mandate is a tax. It’s clearly an effort to get people to buy health insurance, not to tax them.

Here’s why: The ACA abandons decades of reliance on employer-provided health insurance in favor of a market where individuals are buyers. No company with fewer than 50 employees will have to provide health insurance – the vast majority – and after the ACA is implemented, it’s doubtful many small companies will.

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But to make the individual market work, everyone must be in it. If Americans buy health insurance only when they become sick – remember, they can no longer be turned down by insurers – the system won’t work. The nudge toward purchasing is the penalty, an estimated $695 a year, while federal subsidies make insurance affordable for everyone. Given that choice, most people will buy insurance, not pay a penalty and get nothing.

So LePage’s fulminations about freedom and coercion are much ado about nothing.

But he had more to say: “Obamacare is bad policy and bad law. It raises taxes, cuts Medicare for the elderly, gets between patients and their doctors, costs trillions of dollars, and kills jobs.”

Each assertion is either a half-truth or false. Nothing in the ACA “gets between patients and their doctors.” Saying it costs “trillions of dollars” and “kills jobs” ignores the plain fact that American health care costs 50 percent more than anywhere else, and many employees are shackled to their jobs for fear of losing insurance. The ACA may not save us from our fiscal folly, but it won’t make things worse.

Something LePage didn’t say is interesting. Unlike 15 other Republican governors who, for now, are refusing to expand Medicaid, LePage says he’ll decide later.

Why? There’s a clue in a Kaiser Foundation report on state ACA spending, a point widely misrepresented while Congress was debating. The theory was that states like Florida and Texas that offer minimal Medicaid coverage would be big winners, since the federal government pays 100 percent of the expansion for three years, then 90 percent.

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But the bill’s authors were fair. Costs will go up for Florida and Texas, but not for a few states like Maine that already provided expanded Medicaid coverage.

From 2014-19, the state closest to universal coverage, Massachusetts, will gain $1.27 billion. But Maine, with its smaller population, does nearly as well, and nets $118 million from Obamacare. LePage’s hesitation is understandable.

By contrast, Texas will have to pay $2.6 billion and Florida $1.2 billion. But given that in both states, the uninsured rate among residents below age 65 tops 25 percent, it’s still a bargain.

And there’s another trump card. The GOP contention that ACA “cuts Medicare” is a half-truth. The law does reduce Medicare reimbursements by $155 billion over 10 years, but given how much we’re paying, it’s modest, and no one will receive less care. But hospitals are banking on the Medicaid expansion to make up those reductions, because that population now gets charity care. In the end, hospitals may force governors to go along.

Paul LePage has based his administration on the idea that we “can’t afford” to provide health care for citizens, and that Maine will thrive through gutting Medicaid.

The facts say otherwise. No wonder the governor was having a bad week.

Douglas Rooks is a former daily and weekly newspaper editor who has covered the State House for 25 years. He may be reached atdrooks@tds.net.
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