The Medicaid expansion referendum, Question 2 on the November ballot, is critically important to Maine residents and to the viability of rural hospitals.

A “yes” vote would require Maine to expand Medicaid coverage to approximately 80,000 Mainers who currently have no other viable option for coverage — it’s Medicaid or nothing. This means that today 80,000 Maine residents have no access to primary care, preventative medicine, or basic health services that are essential for a healthy life.

Because these Mainers cannot access the care they need to stay well, they only receive medical care when they are very, very sick and are essentially carried into our emergency departments. Many of the illnesses we see could have been completely avoided had the patient been receiving appropriate and ongoing primary care in physician and other provider offices.

Who pays for this care? The blunt answer is, you do — twice.

First, hospitals are forced to charge higher amounts to insured patients — many of you — to cover the patients who are uninsured and cannot pay. Yes, you are paying for their care. This covers a portion of the care provided, but certainly not all. Half of Maine hospitals are losing money because of this problem.

[What opponents of Medicaid expansion get wrong]

The Affordable Care Act significantly cut payments to hospitals and other providers. This has put Maine hospitals in very serious financial trouble. The federally funded expansion of Medicaid under the Affordable Care Act, however, was meant to offset those cuts and keep hospitals and physicians financially viable. But guess what — Maine elected not to play ball. So, we suffered all the cuts in payments brought on by the health care law, but didn’t offset those cuts with available Medicaid expansion dollars. Hospitals in those states that expanded Medicaid are financially OK today — hospitals in Maine are not.

We must fix this mistake before small Maine hospitals that provide vital, life-saving services are forced to close. Make no mistake; closure is a real possibility and a real threat.

Second, as U.S. citizens we all pay our federal income taxes every year. Our hard earned Maine dollars go to Washington and then are distributed out to other states that have already expanded Medicaid. We are currently paying for people in other states to have adequate health care while 80,000 of our own residents go without. How does that grab you? Those are your dollars, but they’re being spent in other states and you’re getting nothing in return for them. A “yes” vote would bring $500 million back to Maine from Washington every year to provide better health care for Mainers.

[Medicaid expansion a rare opportunity to improve health of Maine’s people and economy]

There is a cost to the state budget for this expansion, but it is minimal compared to the $500 million gain. The state budget can and should absorb this increase without affecting your state taxes at all, or at the most, very minimally. Balance that with the benefits the state will receive in return. These funds will have a profound effect on the health of many Mainers and preserve our state’s rural hospitals for years to come.

As stated by the Maine Hospital Association, no public policy proposal is perfect or without challenges. But Medicaid expansion is on balance, very good for needy Maine people and the Maine health care providers who care for them.

Vote “yes” on Question 2 — it is right for you, your neighbors, your hospitals and the state of Maine.

Robert Peterson is the CEO of Millinocket Regional Hospital.

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