Since the end of the legislative session, one of the hot topics behind the scenes is “What happens with Medicaid?” Maine may well be alone in New England next year in not offering coverage to its newly-eligible citizens — 70,000 in Maine’s case — who have no other reasonable chance to access health care.

Full-bore opposition, chiefly from Gov. Paul LePage, convinced just enough Republican House members to back his veto, with the override attempt falling two votes short. This “victory” for LePage could prove short-lived.

Substantial majorities of Mainers favor accepting federal funding — which they will be taxed for, but not receive — and new polling shows their votes against Medicaid could be a real problem for Republicans seeking re-election next year.

One answer would be a voter-initiated referendum. That’s the route Maine Citizens for Clean Elections is taking with the Clean Elections Act, which started losing funding under the Baldacci administration and would have been zeroed out if LePage had his way. Instead, the Legislature restored enough funding to keep the system for legislative candidates, but not the governor’s race; for the first time since 1998, public funding for those candidates will not be available.

The Clean Elections campaign looks not only to restore funding, but to make other improvements concerning contribution limits and donor reporting.

A Medicaid referendum would likely prove equally popular, and offers a significant advantage over submitting regular legislation. Initiated bills go first to the Legislature, so Republicans would have to think hard, one more time, whether they want to deny health care to 70,000 people at no cost to the state.

If they still said no, then the people would get to vote and finally settle the question.

But that’s apparently not going to happen. No group has stepped forward to sponsor a referendum, so action will shift back to the Legislature in January, where emergency legislation – which requires the same two-thirds as for overriding a veto – will be introduced.

House Speaker Mark Eves, who emerged as the champion for health care expansion during the last session, said in an interview this week that he believes there are good prospects for success.

“Since the session ended, and legislators went home and spoke to their constituents, they’ve had to account for their votes. People don’t accept that there’s nothing we can do on health care,” he said.

By January, Maine will be conspicuous in the Northeast in failing to offer Medicaid to all those eligible under the Affordable Care Act. In New Hampshire, where expansion was blocked by Senate Republicans, a special commission could still pave the way to expansion by January.

Eves points out that 25,000 Mainers currently eligible will lose coverage under policies approved while Republicans controlled the Legislature last year. And 2,700 veterans who would have qualified in January will do without.

There’s little doubt that MaineCare, as Medicaid is known here, will be more prominent in 2014 than in 2013. LePage’s vigorous attempts to spotlight previous debt to hospitals dominated the first part of the session. The ultimately successful effort to pass a two-year budget over his veto took much of the remainder of available legislative energy.

Maine’s hospitals, which supported LePage on the Medicaid debt issue, cannot possibly agree with him about MaineCare going forward. Hospitals need the revenue Medicaid provides, and are increasingly dependent on it, with private sector employers still cutting back on health care.

Eves said there will be “all hands on deck” come January. Hospitals will be influential this time after largely deferring to LePage before.

Still, it’s hard to predict how this will come out. Maine has already lost one year of federal funding, more than $250 million, and it can hardly afford to lose a second year – not when every other state in the region has made its peace with Obamacare.

But election years also tend to make things more partisan. That’s the danger is forgoing a referendum on Medicaid. Republicans could simply become more entrenched.

But the citizen Legislature does encourage an unusually close relationship with voters. There’s little support for the proposition that federally funded health care is a bad thing, particularly when Republicans have no answers for how to create an affordable system with universal coverage.

It will be dramatic, but with minds concentrated by the approaching election, it’s hard to see enough legislators continuing to swim against the tide.

Note: Last week’s column incorrectly stated that U.S. Sen. Angus King voted against a comprehensive filibuster reform package. Those amendments to Senate rules, which he co-sponsored, never came to a vote.

Douglas Rooks is a former daily and weekly newspaper editor who has covered the State House for 28 years. He can be reached at drooks@tds.net.

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