Peggy Akers and Ann Woloson want us to believe that Medicaid expansion in Maine would entail nothing but benefits mostly paid for with federal dollars (“Maine Voices: Access to health care would be wonderful way to honor our veterans,” Nov. 11).

Unfortunately, Medicaid expansion is a little more complicated. The federal government would pay for 100 percent of the cost of adding new enrollees over the next three years, and 90 percent afterward.

But the cost to the state for the expanded enrollment would still be significant and would grow. Maine is already struggling with its existing MaineCare program, and expansion advocates ought to at least explain how the state would finance the additional burden.

Meanwhile, the outlook for Medicaid at the national level is grim. The program will be the second fastest-growing expense in the national budget over the next 10 years, and by 2023 outlays are expected to be $572 billion, nearly as much as all nondefense discretionary spending. There is no use pretending that Maine taxpayers are exempt from the cost of rapid entitlement growth.

A better way to help low-income individuals obtain access to health care would be to give them a means-tested refundable tax credit sufficient to purchase catastrophic insurance and to establish a health savings account for minor and routine care.

Unfortunately, at the moment this isn’t possible under the Affordable Care Act, which is designed to limit the control individuals have over their insurance options.

Good intentions that rely on simple and easy government solutions and ignore efficiency and costs don’t necessarily translate into good policy. Advocacy for Medicaid expansion is a textbook example.