Of all the missed opportunities, policy meltdowns and eroded capabilities that have marked state government’s last five years, none stands out quite like the failure to provide health care to 100,000 of our fellow citizens, at no cost to state taxpayers. Yet you’d never know this from reading newspapers or listening to the news.

Maine’s inability to adopt any form of the Medicaid expansion included in the Affordable Care Act is, first of all, a human tragedy. Large numbers of Mainers are growing up with preventable illnesses and untreated, chronic conditions that will require huge amounts of remedial spending down the road — and their quality of life will never recover. And, although it’s somehow considered impolite to mention it, as Sen. Angus King once did, significant numbers will die because they couldn’t afford the care they need.

Thirty-one states have now expanded Medicaid, including half a dozen with Republican governors. A former Republican-turned-independent won the Alaska governorship on a promise to expand Medicaid.

Of the 19 states still refusing to take federal health care funding, virtually all are in the deep South or the Western plains. Maine doesn’t resemble them in any aspect except this one.

Anti-abortion bills have gone nowhere in the Legislature, and Maine was the first state to enact same-sex marriage by referendum. We have experimented with health care expansions over the previous three decades that were among the most innovative in the nation.

Yet we have abandoned this cornerstone commitment — to ensure each resident grows up healthy, with a decent chance for success. Maine is the only state where the number of uninsured children has gone up, not down, over the past three years. What’s worse, we’re not even talking about it.

Gov. Paul LePage endlessly insists adults should never receive a federal or state welfare dollar they’re not absolutely entitled to, but why are we denying health care to children? LePage does bear primary responsibility for this outcome, through his vetoes and misguided claims Medicaid expansion will cost the state money, when every reputable study shows the opposite is true.

But responsibility for that failure is widely shared. When Democrat Mark Eves of North Berwick became House speaker in 2012, he made Medicaid expansion his top priority, pushing numerous bills through to passage in 2013 and 2014 — perhaps unwisely, because it was clear LePage would veto any version and equally clear that, at least before his recent Land for Maine’s Future debacle, Republicans wouldn’t break with the governor on any priority issue.

Then LePage was re-elected and Eves inexplicably dropped the subject. There were no press conferences, no effort to remind voters how important health care is. Few were even aware the one Medicaid bill the House advanced in 2015, L.D. 854, fell one vote short in the now-Republican Senate.

Since that was the time LePage was mysteriously not vetoing bills — under his peculiar theory, firmly rejected by the state Supreme Court, that the Legislature had adjourned — it might have become law had it gotten one more Senate vote.

Responsibility doesn’t end with the Legislature. The Maine Medical Association supports Medicaid expansion, and was once willing to lead a referendum campaign to defend the unpopular “Dirigo taxes” raised to support health care. This time, no campaign.

Maine hospitals were even more conspicuously absent. The whole premise of the Affordable Care Act was that necessary curtailments in Medicare reimbursements would be balanced by new revenue hospitals would gain through Medicaid expansion. Without the expansion, Maine hospitals face $400 million per year in red ink.

The damage is already apparent. Respected pioneers in community-based care such as Franklin Memorial Hospital in Farmington have been forced into mergers to stay afloat. Parkview Hospital in Brunswick, after resisting suggestions it join Mid Coast, finally did so — but only after filing for bankruptcy.

Health care in rural Maine is hemorrhaging jobs and services, yet hospitals have yet to join the debate. They may be deterred because former Maine Hospital Association lobbyist Mary Mayhew is now commissioner of the Department of Health and Human Services, and regularly celebrates the “success” of her policy to deny health care to more and more Mainers.

Yet this is not about what’s expedient, but what’s right. New Hampshire Republicans managed to find a way to expand Medicaid. Republicans in Virginia may follow, now that hospitals there have agreed to a tax to cushion against future costs — even though the federal government will never pay less than 90 percent.

Maine can’t join the 31 states expanding Medicaid if the silence doesn’t end. It’s about time all those responsible found their voices.

Douglas Rooks has covered the State House for 31 years. Email at drooks@tds.net

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