A few months ago, I was close to supporting the proposal to expand Medicaid (MaineCare) in Maine. After all, who could argue with providing health insurance to more Mainers?

As the Legislature began to consider Medicaid expansion before voting it down, however, I did a lot of research and found that it was not what it appeared to be. I also found some other, more fiscally responsible options for extending health coverage to more Mainers.

The expansion proposal would add 70,000 people to Maine’s Medicaid rolls. The feds are offering to cover the cost for the first three years with Maine being responsible for part of the cost after that.

At face value, this appears to be a pretty good deal — free money, right?

But not so fast.

According to Maine’s Department of Health and Human Services, expansion would have cost state taxpayers $150 million per budget down the road. That’s $115 out of the pockets of every man, woman and child in Maine, or $460 for a family of four. Even during the supposedly “free” three years, Maine taxpayers would have to pay more than $10 million in administrative costs and $18 million to expand coverage to thousands not paid for under the feds’ deal.

We’ve been down this road before, and the results have been disastrous. Maine has the third-largest Medicaid program in the country per capita — 50 percent bigger than the national or New England averages. Every year, state government faces massive Medicaid cost overruns. It’s no coincidence that this year’s shortfall is about the same size as the tax increases recently enacted by the Legislature.

For years, we’ve been forced to use tax increases and less funding for other important priorities, such as road repair, public education and law enforcement, to accommodate for Medicaid’s ever-growing slice of the pie, which has almost doubled from 13 percent to 25 percent of the budget in a little more than a decade.

It’s not just numbers on a balance sheet at stake. Our out-of-control welfare programs have real effects on everybody who pays taxes in Maine or relies on basic services such as roads, schools and first responders.

Something has to change.

History shows that Medicaid expansion is also wildly unpredictable. In 2002, Maine significantly expanded Medicaid and expected that 11,000 would sign up. That estimate was far exceeded when 25,000 ultimately signed up and the state had to cap enrollment.

Proponents then, like now, said expansion would reduce uncompensated care at hospitals, emergency room usage and the number of uninsured Mainers.

Since then, however, uncompensated care has tripled, data have shown overwhelmingly that emergency room usage is as great or greater among Medicaid recipients than among the uninsured.

In addition, Maine has not seen a meaningful reduction in the number of uninsured, because many people simply dropped private insurance to obtain Medicaid.

Medicaid expansion has been costly in the past, and there’s no reason to believe it would be any different today.

Furthermore, expansion is not free. Our children and grandchildren will have to pay for it. The question is: Who will be responsible for signing them up for that bill?

Leadership, however, is not just about being the adult in the room who says “no.” It’s about providing long-term alternatives to move our state forward.

We need to focus on making health care affordable, not “free.” Recent Republican-led reforms to Maine’s health insurance market have resulted in price cuts of as much as 70 percent. For example, an Anthem plan that would have cost me, as a 26-year-old man, $242 per month two years ago now costs $116 per month — about as much as a cell phone bill.

Those proposed to be covered under the Medicaid expansion are able-bodied and are disproportionately young men like myself. The vast majority will be eligible for private health insurance programs under the Affordable Care Act via “exchanges” beginning in 2014 at a cost of about $5 per week. This is a great option that provides affordable health insurance without further stretching Maine’s costly Medicaid program.

I recently saw an ad for a $199 per month lease offer on a new sedan and couldn’t help but be reminded of the Medicaid expansion proposal. This 39-month lease requires $0 down, $0 first payment, $0 security deposit and $0 dollars due at signing — just “sign and drive!”

Maybe we should all go get one. After all, who would turn down a “free” car?


Rep. Matt Pouliot, R-Augusta, is serving his freshman term in the Maine House of Representatives, where he sits on the Education and Cultural Affairs Committee.


On Saturday’s Opinion Page, a Maine Compass about the Medicaid expansion vote by Rep. Lori Fowle, D-Augusta, inadvertently omitted her party affiliation.

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