There is a great economic development opportunity on the state ballot this year, but it’s not the one everyone is talking about.

It’s Question 2, which would authorize Maine to accept federal funds to cover health care costs for low-wage earners who are not currently eligible for Medicaid (known here as MaineCare).

A “yes” vote would bring in more than $500 million a year from the federal government, which would be distributed throughout the state to hospitals – including struggling rural hospitals – along with clinics and doctors’ offices, supporting an estimated 4,000 health sector jobs. Those workers will cash their paychecks, buy houses, pay taxes and contribute to the economic health of their communities, generating another 2,000 jobs.

That kind of economic opportunity doesn’t come around every day. For instance, the flow of federal funds that would come to Maine if the state participated in Medicaid expansion would be about twice what the gambling industry calculates as the impact of Maine’s two casinos. The difference is, what’s sent to Maine for Medicaid would be spent in Maine, without any part siphoned off as profits to an out-of-state operator.

For economic impact alone, we would enthusiastically support this referendum, which would give the state a much-needed shot in the arm.

But there are many other reasons to vote yes that are just as compelling. This is a bill that will make Maine’s health care system more reliable and secure for everyone. It will extend access to preventive care and treatment for people who can’t now afford it. And it will save lives.


By passing this referendum, Maine would extend health coverage to an estimated 70,000 people who are not currently eligible for MaineCare, despite earning less than $16,642 for an individual, or $22,411 for a family of two. Some of the people covered would be childless adults who earn less than the federal poverty limit of $12,060 a year, but still can’t get coverage now. More than two-thirds of those who’d be newly eligible are currently working, or actively looking for work, but don’t have employer-provided insurance.

At those incomes, visits to a doctor or filling a prescription are not in the budget. Low-income people often wait until they are very sick before they start to seek help, often at hospital emergency departments. By then, their care might be much more expensive than preventive care would have been. It also might be too late to help them at all.

Even if they have no insurance, those patients are not turned away by hospitals. Instead, they receive “free” care, the cost of which is shared by all the hospital’s paying customers. That results in higher insurance premiums for everyone else.

Opponents typically argue that Maine can’t afford to expand because the state’s 10 percent share of the program, projected to cost $54 million by 2021, would be too much of a burden.

But they are ignoring the benefit the state would get in return from the federal spending on health care. Most investors would be willing to put up $10 dollars to get $100 back, and Maine should be willing to take that deal, too.

Thirty-one states have participated in Medicaid expansion, and there is plenty of evidence that it has not broken the bank.

Instead, expansion states report not only that their state budgets are stable, but that their hospital balance sheets are positive and insurance rates are lower than in non-expansion states.

This is a good deal. It’s time Maine took part in this program.

This is a good deal for Maine, and voters shouldn’t let this opportunity slip away again.

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