Healthcare policy put to voters in Maine, Ohio on Election Day 2017

Two state ballot referendums on Nov. 7 dealt with healthcare issues, with voters in Maine approving an expansion of Medicaid eligibility while Ohio voters soundly rejected a measure to tie pharmaceutical prices paid by the state to rates paid by the U.S. Department of Veteran Affairs (VA).

Maine is the first state to expand Medicaid via referendum, with the “yes” votes winning support from almost 59 percent of voters. One of the supporters of the effort, Maine Equal Justice Partners executive director Robyn Merrill, said the victory could help similar proposed ballot measures in other nonexpansion states like Utah and Idaho in 2018.

“This should be sending a message to the 18 other states that haven’t yet expanded Medicaid,” Merrill said, according to the Portland Press Herald. “This will have national implications.”

Throwing some cold water on the vote was Maine Gov. Paul LePage. He said in a press release a previous attempt at Medicaid expansion, predating the ACA, created a “$750 million debt to hospitals” and failed to reduce emergency department use. In spite of the vote, he pledged he wouldn’t implement the expansion until the state legislature finds a way to pay for it.

The Maine Hospital Association had supported the expansion, saying its members have been operating on thinner margins or in the red already and their financial state would be worsened by cuts to Medicaid’s Disproportionate Share Hospital (DSH) payments. Expanding Medicaid, which would reduce the number of uninsured patients and charity care costs, would help hospitals’ bottom line.

In Ohio, the ballot initiative known as Issue 2 was soundly defeated, with nearly 80 percent of voters opposed. Under the proposed referendum, state agencies which enter into purchasing agreements with pharmaceutical companies, such as the Ohio Department of Medicaid, would have to have prices set or below the rate paid by the VA—which according to proponents, would be about 24 percent lower.

Pharma companies spent heavily to defeat the measure—a total of $58 million, according to the Cleveland Plain Dealer. Both sides of the issue were accused of spreading misinformation or failing to accurately explain what the referendum would do.

This continued even after the vote was conceded. Dennis Willard, spokesman for the referendum’s supporters, told the Plain Dealer Ohioans “voted against their own best interest” because of the pharma industry’s “misleading, lying and negative” campaign. Curt Steiner, campaign manager for the opposition, countered that supporters “made unsubstantiated claims” about lowered prices and savings for the state.

In one instance, the supporters used an image of Cleveland Clinic CEO Toby Cosgrove, MD, in a mail ad, implying he and the clinic supported the initiative. It responded by filing a cease and desist order and demanded the group publicly state Cosgrove and Cleveland Clinic haven’t taken a position on the referendum.