Historically, Maine has been a state with generous safety net programs and a track record of innovative efforts in health system reform, developed under the leadership of Democratic administrations and with frequent support from moderate Republicans. But the 2010 elections in Maine dramatically changed the political balance of power, anointing both a governor and a legislature ideologically at odds with the state's recent political past. Maine has become a bastion of resistance to the Patient Protection and Affordable Care Act, with a reduced Medicaid program, defunded state access initiative, and no state exchange. In addition, the state has adopted a laissez-faire approach to insurance market dysfunction. Using Maine as a case study of the shifts in national political mood, this article describes in broad brushstrokes Maine's history of health reform efforts and recent shift in political direction, and discusses some of the factors that contributed to the change.

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