If I titled columns the way legislators titled bills, I’d probably title this piece: “An Act of Musing on Some Considerations On The Topic of Expanding MaineCare To Noncitizens.”

I don’t have a firm position on any of the bills before the Legislature; I’m not going to tell you how you or anyone else should vote. However, it does seem to me that denying someone who would otherwise qualify for MaineCare coverage, who meets income and residency requirements, purely on the basis of citizenship … doesn’t make a ton of sense.

I think a lot of the knee-jerk opposition to it comes down to racism and nativism; to a mindset of scarcity and “us versus them.” It’s money for us, it’s not supposed to be used for them. But the process of gaining citizenship takes years. There are ways to fast-track it, sure, but those ways usually involve making so much money that paying for health care isn’t a problem.

Maine’s a small state. We don’t have enough of a population to support multiple hospital systems. Rich or poor, citizen or noncitizen, if you get sick enough, you end up at Maine Med.

When MaineCare benefits are used, they stay in Maine. There are some smaller practices that don’t take MaineCare patients, but if you receive health care services at any of the larger groups – MaineHealth, Northern Light – MaineCare reimbursements are an important part of our budget line. Heck, in a convoluted way, I’m sure MaineCare dollars help pay my own (modest) salary, and I’m just a receptionist at an urgent care clinic.

It drives me nuts when politicians (usually conservatives) act like MaineCare is this super cool and awesome treat that we have to guard access to. It’s just health insurance.


Nobody is balling out in the club, throwing their MaineCare card around, making it rain. MaineCare is health insurance, that’s it. All it means is that you get a little green and white card in the mail and can go to the doctor’s office without fear of bankruptcy. If you can find a doctor, that is, and if they will accept MaineCare. I was on MaineCare in 2020 and if you think I’m weird now, things would be so much weirder without the anti-anxiety medication that I was able to keep accessing.

Refusing to spend money on routine and preventative health care might save money in the short term, but the bill will come due; the need for that health care doesn’t go away. The buck stops somewhere, and that somewhere is often the emergency room.

Let’s say an uninsured patient with high blood pressure skips their routine primary care visits and doesn’t get their blood pressure medication refilled. They have a stroke and end up in the emergency room, perhaps with an ICU stay. Instead of the health issue being dealt with by a primary care provider and an appropriate prescription, it now must be treated with a large team of nurses, doctors, imaging, medications, maybe some sort of neurosurgery and intensive rehabilitative care to help the patient recover from the stroke’s effects. That’s a lot more expensive.

If that care is uncompensated, the hospital absorbs the costs and will end up raising the prices of other services, passing it on and spreading it out among other patients. According to a financial update released earlier this year, MaineHealth, the organization I work for (on the lowest possible rung of the company hierarchy), is projected to lose nearly $40 million this fiscal year.

While there are many factors contributing to that picture, uncompensated care is certainly one of them. MaineCare doesn’t actually compensate for the full cost of what it costs to provide services these days, but a MaineCare reimbursement is better than no reimbursement.

What do you expect health care systems to do? And if you say “just don’t treat those people,” please go walk deep into the woods, think about what’s gone wrong with your sense of morality, and stay there until you’ve located some basic humanity.

On a less dramatic level, this is a public health issue, too. There are many self-centered arguments for wanting to improve access to health care for people who are already living in the community. Do you want the person bagging your groceries, cleaning your hotel room or just standing next to you at Hannaford to have an untreated case of strep throat because they were too scared of costs to get their sore throat checked out?

I get that this is a hard topic, and there are a lot of factors involved. I get that money isn’t limitless. But if there’s one thing I’ve learned from working in health care, it’s that ignoring health issues doesn’t make them go away. An ounce of prevention is worth a pound of cure.

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