The case this editorial is about to make is not hard to understand.

Immigrants working in Maine pay into a health care system that they are not allowed to access. Immigrant-led households paid about $194 million in state and local taxes in Maine in 2018, and “that number is certainly higher today,” House Speaker Rachel Talbot Ross, sponsor of L.D. 199, has noted. The estimated cost of the proposal voted down Tuesday evening is $17 million annually. kurhan/

Keeping people healthy pays off. It pays off for families, for parents and their children, for employees and employers, and it pays off in terms of community health.

Granting people access to health care coverage reduces the financial burden of “uncompensated care,” which has to be shouldered by someone in the end. Limits on access to health care drive up the need for costly hospital stays and emergency intervention. The bill comes due eventually – and it tends to be a far bigger bill.

At the very least, the legislative proposal to expand MaineCare coverage to low-income noncitizens gave Maine a chance to avoid footing this bill. But based on the Senate’s rejection of the proposal with no debate and no roll call Tuesday, the proposal looks, at the time of writing, to be in serious trouble. If it dies, Maine will be the worse for it.

To exclude people who live, work and are building a life in Maine from routine health care is to allow preventable illnesses to take hold and to allow conditions that may have been manageable to become chronic. Recent analysis backs this up; one 2020 study found that Affordable Care Act Medicaid expansion led to a reduction in “all-cause mortality” big enough to offset the cost of the expansion.

As more and more Mainers gained access to affordable health insurance, Maine’s uninsured rate experienced the largest decline in the nation in 2021. As the decline was announced last fall, Gov. Mills put it simply: “Health insurance coverage saves lives.” 


It’s sensible to extend coverage to noncitizen residents who cannot otherwise afford to pay for it. It’s also just and right.

In response to the heartless style of us-versus-them argument that is sometimes made on the subject of tax dollars and who they are for, consider the words of House Speaker Rachel Talbot Ross, the sponsor of L.D. 199, in an April op-ed for this newspaper.

Immigrants working in Maine pay into a health care system that they are not allowed to access, Talbot Ross noted, calling it “unfair and tragically short-sighted.” Immigrant contributions came to about $194 million in state and local taxes in Maine in 2018, Talbot Ross continued, adding: “That number is certainly higher today.”

The estimated cost of the proposal voted down Tuesday evening by the Senate is $17 million annually.

Contrary to what some of the critics of L.D. 199 would have you believe, this is not a new idea; Maine provided health care to noncitizens until then-Gov. Paul LePage changed the rules in 2011. Some opponents of the proposal to expand MaineCare to noncitizens have gestured at the recent influx of immigrants as evidence that we can’t afford to expand the coverage. If anything, the transformational pace of new arrivals proves that we can’t afford not to expand it. 

For rural hospitals and clinics, a refusal to expand Medicaid programs like MaineCare can be particularly catastrophic; expansion of coverage to people who can’t afford to pay for it can be a lifeline for health care providers that are catering to large groups of uninsured patients and otherwise strapped for cash. In the past year, hospitals in a number of red states have begun to agitate for Medicaid expansion. Hospitals in Mississippi and Texas projected savings in the billions, were their states to agree to expansion.

The financial and social cost of maintaining restrictions on immigrant access to health care is not something our state should be OK with enduring.

The state senators who voted down the proposal should have been motivated by its major potential upsides for Maine. Expanded access to health care coverage must be looked at like the investment it is. A policy change like this has the potential to both spare us from the negative consequences outlined above and to set us up to prosper, if only we would realize it.

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