THIS MONTH, THE state’s hospitals received checks in the mail to finally pay back $500 million in unpaid Medicaid bills.

Maine’s 39 hospitals received $183.5 million in payments from the state, which unlocks about $300 million in federal payments to the hospitals. Local hospitals receiving money were $9.4 million to Inland Hospital in Waterville, $48 million to MaineGeneral Health in Augusta, and $15.4 million to Franklin Community Health Network in Farmington.

The state fell behind on these bills because of cost overruns in MaineCare, Maine’s Medicaid program, when it was expanded roughly a decade ago to include able-bodied adults.

Instead of being paid for services rendered, our hospitals received IOUs as the state neglected its financial obligations. Gov. Paul LePage and Republican lawmakers implemented a new system for the state to pay its bills just as ordinary Mainers do every day.

On the same day as hospitals finally received their payments, however, Democrats held a press conference to advocate expanding the very program that created the welfare debt in the first place.

Medicaid has proven to be a black hole for taxpayer dollars even beyond the debt to our hospitals.

The politicians who expanded the welfare program in 2001 predicted that 11,000 would enroll; enrollment eventually was capped at 25,000. Maine now has the third-costliest Medicaid program in the country.

During each of my three years in the state Legislature, the Department of Health and Human Services has sought more money to cover Medicaid cost overruns. This year’s shortfall was more than $200 million.

From 1997 to 2012, medical welfare spending by Maine state government has increased 262 percent, doubling as a share of the state budget, crowding out other funding priorities, and leading to tax increases.

Worst of all, the promises of reduced hospital charity care, fewer uninsured Mainers, and less emergency room usage all proved not to be true after previous Medicaid expansions.

Medicaid remains a vital program to ensure that children, elderly and disabled people in Maine have the medical care they need. I believe strongly in helping those who truly can’t help themselves.

Repeated expansions, however, have weakened Medicaid’s core mission, casting the safety net far and wide to include able-bodied individuals and stretching the weave so much that our neediest citizens have fallen through the resulting gaps for lack of funding.

About 3,100 disabled and elderly Mainers remain on waiting lists for crucial services, while free coverage is expanded to those who would not be covered in other states.

We can help either the needy or the able-bodied; taxpayers can’t afford to do both.

After several failed Medicaid expansion experiments, one would think that the debate in Augusta today would be about how to bring welfare spending under control. Amazingly, however, many are advocating the biggest expansion yet.

Welfare expansion proponents cite studies regarding how many federal dollars will be left on the table if we do not expand. The omitted punch line is this: Unless we have $75 million per year from Maine taxpayers to pay our portion of the bill, we will not receive all this “free money” left on the federal table.

Fortunately, thanks to LePage’s fiscal common sense, we were able stop this record-breaking welfare expansion — for now.

It doesn’t have to be this way.

The goal of expanding health coverage to more Mainers is one that we all share; it’s just a matter of how we accomplish it. We can pour more money down the drain of a broken welfare system, or we can create functional, sustainable health insurance markets that provide quality coverage at a low cost while seeking public options for only those who may have no other alternative.

Here in central Maine, the percentage of small businesses seeing rate decreases has risen from 3 percent to a 26 percent, thanks to Republican reforms to Maine’s health insurance regulations. The percentage of small groups seeing large rate increases of 20 percent or more has fallen from 42 percent to 15 percent. A 29-year-old used to pay $332 per month for a private health insurance policy; he or she can now pay $116.

When we have the opportunity to implement reforms instead of simply increasing spending on the same old government programs, I’ll take the reforms any day.

And our hospitals now have the funds to make payroll on time, upgrade medical equipment or build an addition.

Let’s not repeat the same mistake that left them hanging in the past.

Rep. Deborah Sanderson, R-Chelsea, is a CNA who serves on the Legislature’s Health and Human Services Committee.

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