What more can be said about the fight to accept federal funds and provide health care coverage to the poorest among us?

It’s not enough that 70,000 people will go without care; it’s not enough that $1 billion earmarked for Maine will stay in Washington rather than be pumped into the state’s economy; it’s not enough to offer a Republican compromise that wins bipartisan support. The LePage administration and its allies still promise a veto, and there are not yet enough legislators prepared to overturn it.

Our state is poised to be the only one in the Northeast to leave its poorest residents without health care. Why? In some states, conservative governors have proposed purchasing private insurance for some of those newly eligible for Medicaid, but not here. Indeed, the latest salvos from the administration help us understand that this is an ideological fight against the poor and vulnerable. No “able-bodied” need apply for help here — apparently one needs to pass a moral test of worthiness to qualify for health care. That’s not the Maine most of us know and love.

All the noise and fury in this debate may be missing the big question: Is it really the cost of coverage for very poor Mainers that challenges the DHHS budget, or is the loud opposition masking underlying problems that have gone largely unresolved?

The administration argues that it cannot afford to cover about 70,000 Mainers earning less than $16,105 a year. The cost for those newly eligible is fully funded by the federal government, and the state will never pay more than 10 percent of their costs.

We’ve heard that MaineCare is “raiding” other agencies’ budgets; but not about MaineCare’s investments in education or how covering these 70,000 individuals could save Maine millions in state funds. Officials continue to quote the controversial Alexander report, a report that never calculated savings that even a conservative think tank accepts.

For many years, MaineCare has provided savings in K-12 budgets at the state and local levels because it pays for significant services in schools — serving children with special needs, reimbursing school-based rehabilitation, providing speech and other therapies through MaineCare.

Today state funds pay for costly and important mental health and substance abuse services for many whose incomes are just above MaineCare eligibility. MaineCare expansion will create savings to the state when those Mainers become eligible for the program and federal dollars pick up those costs.

Today Maine pays 100 percent of the health costs for our aging prison population. With expansion, MaineCare will pay for those prisoners who meet income eligibility when they are admitted to hospitals. That creates savings in the corrections budget.

When people who are uninsured get sick, the cost of their care is transferred to the rest of us in higher premiums. MaineCare expansion assures that Maine’s hospitals and other providers get paid for service that was previously uncompensated.

We’re told we cannot afford expansion until we cover the waitlists for people who are already receiving MaineCare health services but are waiting for additional supportive services. Why is there a waitlist? MaineCare costs per person are 7 percent higher than the national average. Among states that have moved away from institutionalized care to community services, no state spends more per person on services to the intellectually and developmentally disabled. The tradeoff here is clear — better management of care can reduce high costs and cover the wait list, yet that wait list continues.

Certainly other administrations have had challenges in managing DHHS. And Commissioner Mary Mayhew has launched efforts to reform how services are paid for and delivered. Are they working?

But most importantly, is it right to hold low-income people hostage to management issues at DHHS and inefficiencies in program administration?

Let’s have an honest discussion about the many challenges in DHHS — at Riverview Psychiatric Center, with MaineCare rides, faulty day care oversight, budget overruns, controversy in CDC, a costly and contentious consultant report and more. They can and must be fixed, and that requires collective effort from all parties — not fingerpointing.

The compromise bill before the Legislature — proposed by Republicans and winning bipartisan support — takes on these inefficiencies. It addresses the wait lists, moves MaineCare to managed care, supports DHHS’ current payment reforms, invests in fraud detection, reduces cost shifting to private premiums by covering the uninsured and brings significant federal dollars to Maine, especially rural Maine.

Expansion does not end the debate about MaineCare, but it allows us to discuss the real issue — it is not who the program serves but how well those services are managed that should be the focus of our discussion.

Let’s get beyond ideology and get low-income Mainers covered, then join together with Mayhew to address the department’s larger problems in order to bring costs under control.

Trish Riley has worked under five Maine governors and was the director of the nonpartisan National Academy for State Health Policy. She is a member of the Kaiser Commission on Medicaid and the Uninsured. Her remarks are her own.