Why may LePage flip on Medicaid?

You can credit the Bible or Pete Seeger if you like, but the concept rings true in politics – to everything there is a season and a time to every purpose under the heaven.

And now, as Mainers ponder the mind-boggling flip-flop of Gov. Paul LePage on taking up the federal government’s proposal to expand Medicaid, is as good time as any to keep the phrase in mind.

Despite his uncompromising conservative rhetoric on the campaign trail and since taking office about the proper size of government (small and smaller), sources on both sides of the aisle say LePage is a practical politician, willing to negotiate in exchange for winning a larger prize. In this case, it’s securing support for his liquor contract and hospital repayment plan proposal.

“The governor saw Medicaid as a negotiating tool for the liquor contract and paying back the hospitals,” said one top Democratic aide in Augusta, adding that the calculus may have changed as the politics changed.

Brent Littlefield, one of the governor’s top political advisers, said LePage’s original reticence towards the portion of President Barack Obama’s sweeping healthcare that would let states expand Medicaid was his fear it would cost Maine taxpayers.

“He looked at it originally and just saw the federal government basically putting additional burdens on the states,” Littlefield said.

But even though the law hasn’t changed, LePage’s view of what it means has.

“If the federal government is willing to work with Mainers so that he doesn’t feel like there’s too much of a burden put on the Maine taxpayer than he’s open to looking at that,” Littlefield said.

Littlefield argues LePage’s principles about smaller government still remain, but dismisses  the idea that it’s relevant to the Medicaid issue.

“He always has a general principle about the size of government, he feels like we’re better off if people can make their own decisions rather than a bureaucrat in office telling them what to do. That’s a very basic, core of the philosophy,” Littlefield said. “But in this particular negotiation or discussion, the whole deal is, is there flexibility, is there a willingness to look at designing he feels like it’s something that protects the taxpayers of Maine.”

There’s no doubt LePage’s changing calculus on Medicaid expansion has likely been fueled in part by Republican governors in other states, including fire brand conservative Arizona Gov. Jan Brewer, Florida Gov. Rick Scott and LePage’s confrontational hero, New Jersey Gov. Chris Christie. Many of the Republican governors have found Health and Human Services Secretary Kathleen Sebelius’ office to be willing to cut deals in exchange for insuring more people.

In Arkansas, for instance, the federal government agreed to send money to help insure Medicaid populations, not on the government program, but by private insurers, according to The Washington Post. Another state looking into such a model? None other than Maine, where LePage once said he was “not lifting a finger” to further Obamacare.

“Now he’s looking at, now what are these other deals the other governors are going to get – is D.C. willing to be open to change, is the federal government willing to work with us?” Littlefield said.

Not to get too lost in the weeds, but the details on these Medicaid deals have yet to be fully fleshed out and one private sector healthcare policy analyst said they might be less appetizing to states after they get “tweaked” by the feds.

“Basically for these deals to be approved [by the feds], they have to meet core benefit standards, not push too much cost-sharing onto beneficiaries and be budget neutral – which is not what, for example, Arkansas proposed,” she said. “So, once its gets tweaked to meet [Obamacare] standards, legislatures in places like Arkansas may not like it any more, not matter how gung ho the governor is now.”

Setting policy aside, LePage is negotiating a tough political situation as well. Go figure that some of his most conservative supporters (and yes, those certainly include many who take to the As Maine Goes forum to offer their unvarnished thoughts) are questioning his commitment to principle.

And if the governor hopes by working with the Democrats on Medicaid it will improve his chances at re-election, he may want to look around the country. Florida’s Scott, for example, hasn’t seen a bump in the polls since his Medicaid announcement and has likely only infuriated Republicans who oppose the move.

Some Maine Republicans are already scratching their heads trying to keep up with LePage’s politicking.

“I thought it was unusual based on what he has said in the past,” said one Republican source. “It wouldn’t have been the first time the governor’s message was off. But that’s not the answer I got when I asked [about the Medicaid expansion].”

To everything, there is a season and a time to every purpose, it seems.

Rebekah Metzler

About Rebekah Metzler

Rebekah Metzler is a political writer with U.S. News and World Report, who hails from the state of Maine where she covered state politics for the Lewiston Sun Journal and MaineToday Media. She spent much of 2012 covering the presidential campaign and particularly enjoyed her time on the road in states like Colorado, Florida, Ohio, Ohio and Ohio. Metzler earned her master’s degree in journalism from Boston University and is a Bowdoin College grad.