Mainers for Health Care rally outside the State House prior to Gov. Paul LePage's State of the State address in Augusta, Feb. 13, 2018. Credit: Robert F. Bukaty | AP

As the legal battle over — and Gov. Paul LePage’s adamant opposition to — Medicaid expansion continues, it will be up to the next administration to implement the expansion law approved by voters last year.

If any further proof is needed to show that expanding Medicaid works to improve the health and well-being of low-income working people, a look at what is happening in Kentucky and Arkansas offers important evidence.

After they expanded Medicaid, the two states had the largest drop in the percentage of state residents without health insurance between 2013 and 2016. Kentucky’s uninsured rate dropped by nearly two-thirds and Arkansas’ was cut in half, according to Gallup. All states among the top 10 for shrinking uninsured rates had expanded Medicaid.

Arkansas was one of the first states to expand Medicaid. After it did so, low-income residents were 60 percent less likely to use an emergency room for non-emergency care and they were a third less likely to have trouble paying medical bills, according to a new report from the Center on Budget and Policy Priorities.

Low-income residents in Kentucky were 42 percent less likely to delay medical care because of the cost and 25 percent less likely to skip medications due to the cost.

Low-income residents of both states are now more likely to have a primary care physician and to receive routine health care, which improves their health and lowers costs.

This research, done by Harvard University, compared the two states to Texas, which has not expanded Medicaid. Thirty-three states have expanded Medicaid under provisions of the Affordable Care Act.

With health insurance through Medicaid expansion, residents of Ohio and Michigan said it was easier to look for work and to keep a job, the center’s report said. Health coverage allowed these low-income people to manage chronic diseases, like diabetes and depression, which had made it difficult to work.

Expansion has also helped the financial health of rural hospitals, which have higher operating margins in states that have expanded Medicaid.

This year, the federal government covers 94 percent of the cost of the expanded coverage and it will pay 93 percent next year. After that, the federal share will be 90 percent.

Still, expansion opponents, including LePage, say expansion is unaffordable.

This isn’t the case, according to another recent review from the Center on Budget and Policy Priorities. States have reported substantial savings after expanding Medicaid. For example, hospitals provided less uncompensated care, which is over partially covered by state funds. States also paid less for mental and behavioral health services because they are now covered by the expansion.

“There is ample evidence of the benefits of expansion, from increased health coverage to improved physical and financial health among those who gain coverage,” the left-leaning group concluded. “Claims that higher-than-expected enrollment in some states has harmed state budgets don’t hold up under scrutiny. Expansion continues to save states money or come at a minimal cost.”

In Maine, the LePage administration has finally submitted a plan for Medicaid expansion, as required by law and a court order. However, LePage accompanied the plan with a letter to the U.S. Centers for Medicare and Medicaid Services asking it to reject it because state lawmakers have not come up with a way to pay for it.

Actually lawmakers did, but LePage rejected their plan and his veto was upheld by obsequious Republicans in the Maine House of Representatives.

Although expansion is already the law in Maine, it is an issue to consider when voting on the Nov. 6 ballot. Every candidate for governor says they will implement the expansion, although this is a new position for Republican Shawn Moody, who had opposed expansion. The Legislature must still appropriate funds to pay for implementation, an expenditure some candidates still oppose.

Other states prove that expansion works. Implementing and funding the law in Maine shouldn’t remain up for debate in the next Legislature and administration.

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