AUGUSTA — More than 44,000 Mainers now have access to health coverage through Maine’s health insurance marketplace. As the Portland Press Herald reported May 16, this number includes an estimated 8,000 to 10,000 of the 70,000 Mainers who likely would have qualified for Medicaid if it had been expanded in Maine.

We are glad to know that these Mainers have health coverage, but this does not change the fact that accepting federal funding to expand MaineCare, Maine’s Medicaid program, is the right choice for Maine.

First and foremost, tens of thousands of Mainers are still left with no coverage options. Mainers who live below the federal poverty line – about $11,500 a year for an individual – do not qualify for any subsidies on the marketplace. Unless they are parents, children, people with disabilities or adults older than 65, they do not qualify for MaineCare either, no matter how low their income or how great their need for health care may be. This means that 32,000 of our neighbors – including as many as 2,700 Maine veterans – are left without access to health insurance.

And what about those 8,000 to 10,000 people who would have qualified for MaineCare under expansion, but were able to get marketplace plans instead? Only time will tell how many will be able to continue paying their premiums throughout the year and keep their coverage.

In fact, we already know that 10 percent of enrollees did not pay their first month’s premium. People in this situation are living just above the federal poverty line – between about $11,500 to about $16,000 a year for an individual.

For people living paycheck to paycheck, even a monthly premium of $10 or $15 can be an unsustainable burden. Throw in an unexpected cost like a car repair, an injury that keeps you from working or a job loss, and your ability to keep paying for your insurance becomes less and less likely.

This was the unfortunate experience of a recent caller to our Consumer Assistance HelpLine. When he applied to the marketplace, he was happy to find that he qualified for a plan he could afford with the help of subsidies. But he later lost some of his income. Because of this financial hardship, he wasn’t able to pay his first month’s premium, and his plan was canceled.

If Maine had expanded Medicaid, the solution would be easy. He would transition to MaineCare while his income was low. Once he gets back on his feet and his income goes back up, he would move back into a marketplace plan. But without an expanded Medicaid program, this kind of seamless coverage for people going through hard times is impossible. He is stuck with no coverage until the next marketplace open enrollment for 2015.

We also don’t know how many people with private coverage will be able to afford their co-pays, deductibles and other out-of-pocket costs. After all, the goal is not just to get an insurance card in your wallet – it’s also about being able to get care when you and your family need it. Low-income Mainers with subsidized marketplace plans who are not used to having private insurance may be surprised to find out what they owe when they see a specialist or pick up a costly specialty prescription.

Even Maine Community Health Options, the company with the most marketplace enrollments, agrees that Medicaid expansion would be better for many low-income Mainers.

Maine Community Health Options CEO Kevin Lewis said, “Those just over the poverty line may be unable to afford even the subsidized cost sharing: an adverse health event or condition resulting in hundreds of dollars of cost sharing may be untenable for those struggling to pay for heat, food and shelter.”

Medicaid expansion is also the best use of our federal tax dollars. According to an analysis by the progressive Center on Budget and Policy Priorities, it costs less to cover someone under Medicaid than through private insurance. Both the subsidies available through the marketplace and the funding for expansion are paid for with federal money. Don’t we want to spend our federal tax dollars in the most efficient way possible?

The need for health care for people with low incomes does not go away just because the issue is no longer before the Legislature. All Mainers would benefit from Medicaid expansion as a smarter, more efficient use of limited health care dollars to ensure people are able to live healthy and productive lives, without having to decide between a trip to the doctor or paying their bills.

— Special to the Press Herald