When poor Americans don’t have health insurance, they don’t get health care. That’s the simple conclusion that drove the creation of the Affordable Care Act, with the goal of making health insurance more affordable and accessible to those American who don’t have it. The act also allowed states to expand Medicaid to reach low-income Americans without insurance.

This simple conclusion was bolstered by a recent analysis in Maine that found that half the state’s uninsured low-income residents did not have a regular source of care. A similar percentage had trouble paying medical bills. As a result, they put off needed care, endangering their well-being.

“Compared with their insured counterparts, low-income uninsured Mainers have more trouble finding a health care provider to see them, are less likely to seek needed medical services, and have greater difficulty paying their medical bills when they do obtain health care,” says the report by the Muskie School of Public Service and the Maine Health Access Foundation.

This is an important message to keep in mind as lawmakers in Augusta debate the implementation of Medicaid expansion in Maine.

Last year, voters strongly endorsed an expansion of Medicaid in Maine, making the state the 32nd to expand the public health insurance program.

By expanding Medicaid, Maine will make insurance coverage available to 80,000 Mainers. These are people who work but can’t afford health insurance or their employer doesn’t offer it. They are not poor enough or do not have a disability to qualify for Medicaid without an expansion. Under the ACA, the federal government covers 90 percent of the cost. Maine is estimated to receive more than $525 million per year for a state investment of about $55 million annually, beginning in 2021, the first full year of implementation.

With health insurance, 80,000 more Mainers can access preventative care, vaccinations, addiction treatment, counseling and other needed care. Currently, many people without insurance put off doctor’s visits until illnesses or injuries become so bad they threaten their work and well-being. When they do seek care, it is more expensive.

Fifty-four percent of low-income uninsured Mainer adults have no regular health care provider and 27 percent had trouble finding a doctor who would see them when they needed one, the Maine Health Access and Muskie School analysis found. Affordable care is another barrier as 51 percent of those without insurance had trouble paying medical bills. As a result, nearly half put off medical care or purchasing prescriptions and 54 percent put off dental care. These percentages are much higher than for low-income adults in Maine who do have insurance.

By extending insurance to 80,000 more Mainers, Medicaid expansion will make medical care more accessible and affordable. It will also put Maine hospitals on more secure financial footing by reducing their uncompensated care and expanding their patient base. In many rural communities, hospitals are the largest employers.

It will also help the state’s economy as billions of federal dollars flow into the state, creating 6,000 new jobs, according to a report by Elizabeth Kilbreth of the Muskie School.

Yet, opponents, led by Gov. Paul LePage, argue that Maine can’t afford the expansion and are working to stop or delay it. A state implementation plan is supposed to be filed with the federal government Tuesday, but it is unclear if the administration will meet this deadline.

LePage has thrown out demands — that paying for expansion can’t raise taxes or take funds from other programs, for example. This can easily be done.

Maine lawmakers must ignore the grandstanding and demands from LePage. Remember, the Legislature approved expansion five times and each time LePage vetoed it, setting up November’s vote. They must also focus on verified budget numbers, not the scary, skewed versions shared by LePage.

Mainers have said extending health insurance to their friends, co-workers and neighbors who don’t have it is their priority. It is time for lawmakers to make that a reality.

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