On Tuesday, voters in Maine will decide whether to create the nation’s first universal public home care benefit for older adults and younger people with disabilities. The hotly debated referendum, Ballot Question 1, would be funded through a surtax on high-income households.
The measure was introduced by the Main People’s Alliance and is supported by many progressive and consumer groups. It is opposed by a broad coalition of business and health care organizations and by all four candidates for governor.
The ballot language is simple:
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?
The referendum would make home care benefits available to all Mainers regardless of income. That’s far more expansive than Medicaid’s long-term care benefit, which limits eligibility to those with very low incomes and few financial assets as well as a high level of need for personal assistance.
It is not clear how generous the Maine program would be. The size of the public program would depend on how much revenue the tax raises. The program would be explicitly barred from spending more than the tax brings in.
The state estimates new levy would raise about $310 million annually. Supporters say about 27,000 residents need home care. Some quick math suggests that if all 27,000 were eligible for the benefit, the new program would pay for an average of 10-15 hours per week of home care.
But its actual design would be left to an independent commission—the Universal Home Care Trust Fund Board. It would create a structure for determining eligibility, assessing need, and assuring quality of care, as well as managing the funds.
Home care agencies would have to spend at least 77 percent of state payments on wages, training, and development for home care workers. Aides hired directly by clients would be treated as state employees under labor laws.
The ballot initiative sets a tax rate of 3.8 percent on all Maine adjusted gross income in excess of the current federal Social Security payroll tax cap (currently $128,400 but adjusted for inflation each year). However, unlike the federal payroll tax, the Maine home care tax would apply to all income.
The tax on wage income would be divided equally between employers and employees (each would pay a 1.9 percent rate). High income residents would pay the full 3.8 percent on non-wage income above the threshold.
There is some dispute about that threshold. The intent of the referendum appears to impose the tax on individual income that exceeds the $128,400 floor. But critics say the proposal is ambiguous and could be read to mean household income above $128,400. Supporters say they’d ask the legislature to clarify the language should the referendum pass to make clear it applies to individuals, thus the threshold for a couple filing jointly would be $256,800. That would reduce to about 3 percent the share of Mainers who would pay the tax, but also limit the amount of revenue the tax would collect and the benefits the program could provide.
An odd history
The history of ballot initiatives in Maine is an odd one. In recent years, voters have been willing to pass measures while electing lawmakers who refuse to implement them. For example, last November, Maine voters overwhelmingly approved a referendum to expand Medicaid–as nearly two dozen other states have done since passage of the 2010 Affordable Care Act. But Gov. Paul LePage, (who cannot run for reelection) has refused to implement the law.
I have seen no public polls on the home care initiative, so the outcome of this ambitious effort is very much up in the air. Other states, including, Hawaii, Washington, and Minnesota, have been working on their own plans. With the federal government locked in policy gridlock, it looks like momentum for a universal long-term care program is in the states. On Tuesday, we’ll learn just how strong that momentum is.