In New England, Maine governor Paul LePage is the lone healthcare holdout, refusing to take advantage of the expanded Medicaid program that will be offered under the Affordable Care Act beginning next year. LePage still intends to turn his back on $3 billion in federal aid that the state would receive over the next 10 years if it participated in the program.

The governor’s determination not to participate is clearly a matter of ideology, not economy, and it remains to be seen whether his constituents are willing to suffer with everything from back pain to cancer to coddle his belief that the Affordable Care Act is not constitutional—even after the Supreme Court has decided that it is.

It’s ironic that Florida governor Rick Scott, under whose right-wing regime it’s become easier to tote a gun and harder to vote in the Sunshine State, has recently decided to go with Obamacare’s Medicaid expansion, reversing his earlier resistance and outraging his Tea Party constituents. Making it easier for Scott to square his decision with conservatives is a deal the feds have concluded with Florida that will allow the state to offer some Medicaid benefits through private insurers.

Scott said he wouldn’t withhold health benefits from an expanded recipient pool since for the first three years, the federal government would pay 100 percent of the costs. Until now, his state has had notoriously restrictive eligibility guidelines for Medicaid; “Today, a single parent with two children can’t qualify for Medicaid in Florida if she makes more than $3,200 a year—one of the nation’s lowest eligibility levels,” Kevin Drum reported in the Feb. 20th issue of Mother Jones.

But LePage, the governor of a state that ranks 27th out of 50 in terms of per capita income and is definitely the poor relation compared with the rest of New England (where Connecticut ranks 4th, Massachusetts 5th, New Hampshire 6th, Rhode Island 17th and Vermont 19th), stands pat. In fact, he’s not just standing pat; besides rejecting the Medicaid expansion, he’s cutting back on Maine’s existing Medicaid program. By the end of the year, 44,000 Maine residents will lose their Medicaid coverage. Twenty thousand have lost their benefits this month.

LePage, who worked his way up from a background marked by poverty and homelessness, has consistently dealt with his state’s low-income residents in a tough-love style that puts the emphasis on tough. He has said that MaineCare, Maine’s Medicaid program, has too many clients, and eligibility guidelines that are too liberal.

Elected in 2010 by only 38 percent of Maine voters, LePage gained national attention after he took office in 2011 by removing a mural depicting scenes from the history of labor in the state from the building that houses Maine’s Department of Labor. LePage said the mural, with its images of the legendary Rosie the Riveter and other notables from the annals of labor, glorified workers at the expense of entrepreneurs. A storm of protest finally led to the rehanging of the mural in the entryway to the Maine State Museum two months ago.

LePage is one of 14 governors who were still refusing to participate in the expanded Medicaid program at press time. Many Republican governors who originally opposed the Affordable Care Act, including New Jersey’s outspoken Chris Christie, have signed their states up for the expansion, since doing so will enable them to cover more residents needing health care at no additional expense to their states. The states whose governors were refusing to participate last week were Maine, Pennsylvania, North and South Carolina, Mississippi, Louisiana, Georgia, Alabama, South Dakota, Idaho, Wisconsin, Iowa, Oklahoma and Texas, which has the highest percentage of uninsured residents (26.3) in the country. Scott’s decision to place Florida in the program, after Florida had led a 26-state suit challenging the constitutionality of the Affordable Care Act, is seen as a serious blow to Republican hopes of getting the law repealed.•