Maine voters to decide whether to adopt new aging benefit

October 24, 2018

Maine was the first state to adopt its proposed Medicaid expansion by a ballot initiative, which voters in several other states will be considering on election day. This November, Maine voters will vote on another first: whether the state should adopt by referendum a new home-health benefit to assist its aging population.

A group of progressive organizations such as the Maine’s People Alliance submitted enough signatures to put Maine Question 1, the Payroll and Non-Wage Income Taxes for Home Care Program Initiative, on the November ballot. Question 1 asks:

Do you want to create the Universal Home Care Program to provide home-based assistance to people with disabilities and senior citizens, regardless of income, funded by a new 3.8% tax on individuals and families with Maine wage and adjusted gross income above the amount subject to Social Security taxes, which is $128,400 in 2018?

If Question 1 passes, then Maine would adopt a new universal home-health benefit for long-term care support services to older Mainers and those with disabilities regardless of income. Home health would allow such individuals to receive medical care but also personal-care support services to help with daily living; such services may enable older adults and people with disabilities to remain at home instead of requiring care in a skilled nursing facility or nursing home. Question 1 also would create a payroll tax, which is estimated to generate more than $300 million annually, to establish a privately-managed trust fund that would implement and pay for the new benefit.

One key concern is that while more Mainers may need home health, a state report found that Maine is facing a shortage of home-health workers. Opponents argue that Question 1 would make the shortage worse by increasing the demand for services, but proponents argue that the trust fund board could use its tax revenues to improve wages for home-health workers and provide training opportunities for young people, who often are moving out of New England often in search for work.

Unlike Maine’s successful 2017 ballot initiative to expand Medicaid, Maine’s gubernatorial candidates do not support the home-health ballot initiative. Additionally, many industry stakeholders such as the Maine Hospital Association oppose the initiative. Opponents raise several arguments such as the impact of a new tax, whether the new tax would impose a “marriage penalty” on couples, and the legality of how the trust fund’s board is selected.

Regardless of whether the ballot initiative is successful, the effort in Maine will help bring attention to aging issues and the need to develop a strategy to help the “graying” population in the United States with their long-term care needs. The federal government failed to implement a long-term care insurance program, the Community Living Assistance Services and Supports (CLASS) Act, which was authorized by the Affordable Care Act: in 2014, Health and Human Services Secretary Kathleen Sebelius said that CLASS could not be implemented in a fiscally sound way, and Congress subsequently repealed CLASS’s authorization.

CSG’s Eastern Regional Conference is home to some of the states with the oldest population. According to the Census Bureau, Maine is still the nation’s oldest state and getting older: by 2034, the share of people age 65 and older in Maine will rise from 15.6 percent to 27.8 percent.  Other ERC members — Pennsylvania, Vermont, Delaware, New York, New Hampshire, and Rhode Island — are also in the top ten states with the highest percentage of adults over 65 years old.

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