Congress is weighing cuts to Medicaid that could reshape our health care landscape in ways that go far beyond the one in five Americans who rely on it for coverage. In Maine, that’s 400,000 people. If you’re not one of them, it’s easy to think these proposals won’t affect you. But they will — and here’s why.

Medicaid is a financial backbone for many hospitals, especially in rural areas. Medicaid covers one in five hospital discharges and nearly half of all births in rural hospitals nationally. In Maine, Medicaid paid for 48% of rural births and 39% of all births in 2023. For Maine’s Northern Light hospital system, MaineCare revenue ranges between 12% and 64%.

Expanded Medicaid has reduced the number of uninsured patients, lowering hospital costs for uncompensated treatment of patients without insurance, or “charity care.” In Maine, charity care fell from $234 million in 2018 to $133 million in 2023.

Many hospitals, particularly in rural areas, are already on shaky financial ground. Medicaid cuts could force lower reimbursement rates or result in higher levels of uncompensated care when uninsured patients can’t pay. That pushes hospitals further into the red — and could lead to service reductions or closures. This is especially concerning in rural areas, where provider options are limited and the loss of a single hospital can mean residents must travel hours for essential care.

The fact is, someone you love — or you — might need Medicaid someday. Medicaid can be an essential support when people are at vulnerable points in their lives. It covers two in five children, two in five non-elderly adults with disabilities, one in four people with a substance use disorder or mental illness and three in five residents of nursing homes.

Long-term care is a critical example. Medicare, the health insurance program for older adults, doesn’t cover extended nursing home stays or in-home support for complex needs. Medicaid does — but only after individuals have spent down most of their personal assets or exhausted other insurance. When all other resources are gone, Medicaid steps in.

The same is true for families with children who have disabilities or other special needs. In Maine, roughly half of those children rely on Medicaid or the related Children’s Health Insurance Program for coverage. Medicaid also plays a vital role in providing substance use treatment and recovery services — resources that help entire communities stay safer and healthier.

Did you know Medicaid brings federal dollars to Maine — helping all of us? Every federal Medicaid dollar frees up state dollars that can be used elsewhere — in public education, child care, housing, roads and local aid to towns. Major cuts to Medicaid would pull hundreds of millions of dollars from Maine’s budget, forcing lawmakers to make difficult choices: reduce health care access, scale back other community investments or explore new revenue options to close the gap.

Efforts to raise state revenues — such as through more equitable tax policies — are already underway to address existing shortfalls. These strategies can be part of a balanced approach, but they may not be sufficient to offset the full impact of large federal cuts.

And here’s one more reason Medicaid matters: you might be on Medicaid without even realizing it. Many states use a different name for their Medicaid programs — Maine calls it “MaineCare.” The word “Medicaid” doesn’t appear on the insurance card at all. In some states, private insurance companies administer the program, making it even harder to identify. That means the reach of Medicaid is often underestimated.

Many Americans, especially working adults in low-wage jobs that don’t offer insurance, rely on Medicaid without knowing it. Without this coverage, their only option is to go uninsured.

We all benefit from a health care system where hospitals stay open and people can get health care when they need it. Medicaid helps make that possible. Cutting it doesn’t just affect “other people.” It affects us all.