SCARBOROUGH — In war, they say, truth is the first casualty. The raging debate over health care isn’t exactly war, but the truth has taken a beating when it comes to the expansion of MaineCare.

Let’s review.

The expansion of MaineCare, or Medicaid, would add an estimated 70,000 able-bodied low-income Mainers to the program, which currently enrolls about 330,000 people, making it already the third largest Medicaid program in the nation based on population. New Hampshire, with similar demographics, has only 118,000 residents on Medicaid.

Maine has repeatedly expanded the program, and currently, more than one in four Mainers are enrolled in this no-premium, no co-pay, no-deductible and no-sliding scale program.

Who pays for this program? The taxpayers pay for it through a combination of state and federal taxes.

Maine has already expanded MaineCare eligibility past the breaking point. For many years Maine has been struggling to balance the budget and pay MaineCare bills. That’s why Maine hospitals were owed $737 million for Medicaid services dating back to 2006.

Apparently, the Democratic majority approach was to add large new categories of people to MaineCare, then neglect to pay significant bills when it came time to settle up at the end of the year, and kick the can down the road to land on Paul LePage’s lap.

With unwavering determination, Gov. LePage recently made the final payments to Maine’s 39 grateful hospitals. And, under his leadership, the billing system has transitioned to a pay-as-we-go system so that debts of this magnitude cannot as easily accrue in the future.

Enter the Patient Protection and Affordable Care Act – Obamacare.

Now we are told that, through Obamacare, the federal government will pay 100 percent of the cost for the first three years for the millions of new people expected to stream into Medicaid. Sounds like a good deal, right? But, for Maine, that is true for only a portion of the expansion. Maine’s already-relaxed standards have come back to bite us, because the tens of thousands of people we previously added are not covered by the 100 percent guarantee.

Other states, less charitable than Maine, will now add the very same categories of people to their Medicaid programs that we have already enrolled. However, those states will receive the 100 percent reimbursement. Maine won’t. We will have to make do with a variable and decreasing federal match – currently 61.5 percent. This means Mainers will pay millions of dollars during the “free” years.

Gov. LePage appealed to the feds to get the same 100 percent deal as other states. Unfortunately for him, and for Maine taxpayers, too, his plea was rejected. In essence, the taxpayers in our poor rural state are being punished for having been so generous with previous Medicaid expansions.

Some argue that the newly eligible 70,000 recipients would be “free” for the first three years, with the federal match subsequently declining to 90 percent. They say we are leaving hundreds of millions of dollars on the table. In their view, we’d be foolish to pass up such a terrific deal.

While the governor’s veto on Medicaid expansion was sustained along party lines, legislators don’t want low-income people to go without medical coverage. The fact is, most of those who don’t qualify for MaineCare will qualify for Obamacare’s huge subsidies to access private insurance through the Health Insurance Marketplace. And it is my understanding that the mission of the Affordable Care Act was not to promote “free” insurance as much as it was to provide affordable access.

Moreover, there are significant administrative costs. The state would need to hire 93 new employees to handle the heavier workload, at an annual total cost of $7 million.

But the big blows come to the General Fund once the match drops to 90 percent. Looking ahead, the state estimates the resulting 10 percent of the cost will result in an additional $70 million cost in the fiscal 2016-2017 budget.

And the cost leaps to $150 million in the fiscal 2020-2021 biennial budget. And as evidenced recently, if a future cash-strapped Congress reduces the 90 percent match, all bets are off.

Remember, these are just estimates. Every year, Maine Department of Health and Human Services spending is underestimated, and Medicaid enrollment, for certain populations, has been capped because of a heavier-than-expected influx.

Maine taxpayers already fork over almost $1 billion a year for our share of MaineCare. Is it fair to ask them to take on this new burden, when insurance subsidies will soon be available?

— Special to the Press Herald