During the time that I have been in the Maine Senate, Medicaid expansion is, by far, the most difficult issue that I have encountered.

Over the past year, I have had many meetings to listen to the concerns of my constituents.

Many of their stories were difficult to hear. No one can argue that this great country isn’t taking care of the truly needy the way it should.

Last year, I was actively involved in creating an amendment to the expansion bill that did make it better, but not good enough.

I was also involved this past year with a small group that created what is known as the Katz/Saviello amendment to Medicaid expansion, and it, too, makes it a better bill. It includes a managed care provision that calls for the state to contract with private companies to manage Medicaid recipients’ health care.

I believe that the most efficient way to control costs in the long term is to convert to this type of system. This would improve access to health care in rural areas, assist the Department of Health and Human Services to transition to a model already working for other states, and keep the program within the budgeted money as it adds participants.

But there are issues that have given me many sleepless nights:

1. We have just completed a supplemental budget to balance our 2014 budget and at least the first half-year budget for 2015. DHHS said it needed an additional $45 million to meet its projected new needs. We were able to only give the department $31 million.

2. The MaineCare program without expansion is 23 percent of the state’s total budget and growing. It will consume about 30 percent of our total budget within five years. This is unsustainable.

3. Previously, the costs involved with the expansion of MaineCare were severely underestimated. That is the cause of many of our current budget problems such as the underfunding of education, municipal revenue sharing, nursing homes and important government services such as public safety and the court system. It’s also led to increased sales taxes and other fees, more than a half-billion-dollar debt to our hospitals and longer waiting lists for people with severe handicaps. The list goes on and on.

4. The bill has a sunset after three years, which gives a future Legislature the option of rolling back the expansion. This is a lot like giving someone a nice new home but telling them not to get too attached because in three years they’re going to be kicked out.

5. DHHS projects that the three-year trial period will require it to budget about $84 million to cover costs.

6. Free insurance, “MaineCare,” is provided to 319,000 individuals. Expansion, if projections are correct, will add 70,000 people almost immediately and up to 100,000 over the next 10 years.

7. If the bill passes, it will not become law until July. It would take another year or more for the Request for Proposal process to be completed to choose three or four managed care companies to run the program. We would already be two years into the three-year sunset. With only one year under our belt, can we really evaluate the effectiveness of the expansion?

8. Will the federal government pay the promised 90 percent starting in 2020? Even if it does, Maine’s share would be $100 million to $150 million per year. Thirty-eight percent of the state budget would be used to fund MaineCare. Devastating.

9. Will the federal government allow us to get out of the program after three years?

Everyone who is at or above the federal poverty level can buy insurance through the Affordable Care Act exchanges. This should eliminate an estimated 35,000 people from going on MaineCare. Generally, if your income is less than 100 percent of the federal poverty level, you are not eligible for a subsidy. But if you anticipate that your annual income will be at or exceed the federal poverty level, you qualify. There are no penalties for not reaching your goal.

Recently, I helped a constituent access the federal exchanges. She found she could buy a health insurance plan for $1 a month. It comes with $5 co-pays for doctor’s visits and a $200 deductible.

These are some of the issues that I have worked hard to reconcile. I have approached this effort with an open mind and have tried to find a way to make it work. We do have people who are unemployable. They need our help, and we must find a way to ensure that we have a system that meets their medical needs. I am committed to working toward that goal. But this proposal is not the answer.

Sen. Ed Youngblood, R-Brewer, represents Maine Senate District 31. He serves on the Maine Legislature’s Energy, Utilities, and Technology and Government Oversight committees.