The newspaper recently editorialized against the LePage administration’s decision to reject Medicaid expansion, “Map of uninsured puts Maine county in Confederacy” (Nov. 3). Setting aside the newspaper’s unfortunate tone, the policy discussion is an important one.

The Affordable Care Act, as enacted, required states to expand eligibility of their Medicaid programs. In 2012, however, the Supreme Court struck down that mandate, making expansion optional and setting off policy debates in state capitals across the country. In addition to Maine, 19 other states — located throughout the South, Midwest and West — have rejected expansion.

Expanding MaineCare — Maine’s Medicaid program — would have required our state to add thousands of childless, able-bodied adults to the program’s rolls and to increase Medicaid eligibility for parents of dependent children. For both groups, expansion would have broadened program eligibility to include those with incomes of up to 138 percent of the federal poverty level. This would have come at a cost to Maine taxpayers of more than $220 million during the next five years, and it ignores the fact that any individual who earns at least 100 percent of the federal poverty level is eligible to purchase subsidized health insurance on the federal exchange. Accordingly, most childless, able-bodied adults — and all parents who do not qualify for MaineCare — have access to subsidized health insurance under the current system.

Rather than expanding MaineCare, then, the Maine Department of Health and Human Services has refocused the program on its neediest and most vulnerable beneficiaries. I wrote about this dynamic in these pages several months ago, noting how right-sizing MaineCare and rejecting expansion have helped stabilize the program’s growth and put it on sustainable financial footing.

Containing growth in a program that accounts for one-quarter of our state’s budget — and forecasting its expenditures accurately — has provided the department the opportunity to invest in areas of acute need. Gov. Paul LePage’s two-year budget proposal reflected those priorities, whereby his budget sought increases of $46 million in funding to reduce waiting lists for services for the intellectually and developmentally disabled; $28 million to expand access to primary care; and $22 million to adequately fund Maine’s nursing homes.

Had Maine expanded Medicaid, none of these investments would have been possible. Instead, our state likely would be facing looming budget shortfalls and troubling policy decisions about how to address them. This is what happened when Maine expanded Medicaid in 2002 — the genesis of long waiting lists, underfunded nursing homes and large unpaid bills to the hospitals — and this is what we are seeing in other expansion states today.

According to Vermont Public Radio, costs for that state’s Medicaid program are running $105 million over budget in the current fiscal year. Even with the enhanced federal match, taxpayers may owe $40 million of that funding, and the Shumlin administration and Vermont legislators already are considering cutting back services to Medicaid beneficiaries.

Illinois, Oregon and Kentucky are experiencing equally concerning results. According to the Chicago Tribune, the Illinois Department of Healthcare and Family Services originally projected that Medicaid expansion would add 342,000 Illinoisans to the program’s rolls and increase costs by $573 million from 2017 to 2020. The state has since revised those predictions to 540,877 new enrollees at a cost of at least $907 million, leaving a budget gap of more than $330 million.

Likewise, in Oregon, The Associated Press reports that Medicaid expansion will cost the state 70 percent more than initially expected. Rather than the $217 million that state officials projected from 2017 to 2019, Medicaid expansion will cost $369 million, a gap of $152 million. Moreover, Kentucky’s projected Medicaid expenditure for 2017 alone ballooned from $33 million to $74 million.

Most recently, the Albuquerque Journal reported that New Mexico legislators have requested an additional $85 million in Medicaid funding for the coming fiscal year “to keep up with skyrocketing enrollment and a looming decrease in the federal matching rate.” As the federal match recedes further, New Mexico and other Medicaid expansion states likely will face even larger cost overruns. To keep their budgets balanced, policymakers in those states will need to decide whether to raise taxes, repurpose other state resources or cut Medicaid rates and services.

In Maine, thanks to the LePage administration’s prudent management of MaineCare and rejection of program expansion, we are not facing those troubling policy decisions. Instead, under the leadership of Commissioner Mary Mayhew, DHHS is reorienting MaineCare to our state’s neediest and most vulnerable and maximizing the efficiency and effectiveness of a program that serves more than 20 percent of all Mainers.

Alec Porteous is deputy commissioner of finance for Maine’s Department of Health and Human Services.

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