One of us is a doctor in Milbridge, battling on the front lines of the opioid epidemic. The other is executive director of a human needs advocacy group in Washington, D.C., battling on the front lines of the health care and budget fights in Congress.

We are deeply concerned – as are many Maine families – about proposed massive cuts to Medicaid, both in terms of dollars (hundreds of billions) and the number of people who would lose care tens of millions of Americans.

Why are we so concerned? Let’s look at the numbers. According to the nonpartisan Kaiser Family Foundation, 267,000 Mainers received quality health coverage through Medicaid or through the Children’s Health Insurance Program. Most Medicaid recipients are children, pregnant women, seniors and people with disabilities. Maine is a relatively poor state (almost one-third of Maine’s residents are considered low-income); roughly one in five people receives coverage from Medicaid or CHIP.

But let’s dig a little deeper into the most recent numbers – that will help us understand what’s at stake and why people are deeply concerned.

In 2014, Medicaid provided 76,900 people with disabilities in Maine access to critical care that helps them live independently. That’s more than a third of Mainers with disabilities.

I think of my patient Gwen, who recently lost a leg from her continued smoking. She has tried to stop, but addictions are hard. She can still live at home because of the help she receives from MaineCare, including the rides to my office. What will become of her? Or my patient Nancy, who became a paraplegic after being a passenger in a car accident. She is still home with her mother, brothers and young daughter. I still have to fight for many of the things she needs (like a lift to help her get out of bed), but she is home with family. What becomes of her?

In 2014, Medicaid provided 64,500 of Maine’s seniors with health care, including nursing home care and services that help them live at home. That’s 29 percent of the state’s senior population.
In 2015, Medicaid helped 5,421 of Maine’s babies get a healthy start in life. That was 43 percent of the births in the state. Yes, you read that correctly – nearly half of the babies in Maine rely on Medicaid for their care, meaning that Maine’s kids are particularly vulnerable to cuts to Medicaid. Every single child I see in the office in Milbridge is on MaineCare. Yes, 100 percent.

If there are cuts and children lose access to preventive services, we will lose another generation. We already have a rising infant mortality rate in Maine. Imagine how much worse that would be if pregnant women do not have access to care.

And, of course, there is the crisis of opioid addiction. In 2015, Maine recorded an opioid death rate of 19.3 people per 100,000 population – that is almost double the national average and was an alarming 41 percent increase from the fatal opioid overdose rate the year before. Preliminary numbers from 2016 are higher.

More people are dying from opioid addiction than from the wars in Afghanistan and Iraq combined, or from HIV. Or gun violence. Or car accidents.

Last year, Maine experienced 376 overdose deaths, more than one per day, and of those, 313 deaths were attributed to opioids. What happens to Robin, a mother of two small children, who is now stable on Suboxone and coming to weekly groups to face what led her down the rabbit hole of addiction to begin with? What happens to John, a fisherman who no longer loses all his income to heroin but now can support his family because he’s in recovery?

The beauty of Medicaid is that the program can expand to cover emergencies like opioids or other health crises, like Zika or swine flu (or whatever the next epidemic will be).
But Medicaid cannot expand to effectively address the next emergency that is coming down the road if we cut the program by hundreds of billions of dollars and restructure it practically out of existence. Maine already reimburses at one of the lowest rates in the country, which may explain the low rate of health care providers who’ve gotten the required federal waiver to prescribe buprenorphine (only 4 percent of eligible prescribers rise to this challenge).

The proposed cuts both in the Senate health care legislation and in a budget proposal soon to be brought forward in the Republican-controlled House are a direct attack on the interests of the people of Maine. We must ask our members of Congress, Sens. Susan Collins and Angus King, and Reps. Chellie Pingree and Bruce Poliquin, to defend Maine’s most vulnerable people.