In a recent opinion piece published by the Portland Press Herald, one of the authors promotes a new study as evidence that the MaineCare expansion is working. They specifically note that more people are covered and more are getting their annual physicals than before.
But that’s what you would expect to happen when you expand taxpayer-funded coverage. The study also fails to tell us if Mainers are actually healthier; nor does it address the cost issue and whether this optional government-run health insurance program is worth funding. With an estimated $1.085 billion budget shortfall looming, legislators need to know the costs and benefits of MaineCare. This study doesn’t answer those questions and instead treats the predictable increase in coverage as sufficient evidence of the expansion’s success.
More coverage is an expected result
The paper, written by Jordan Rhodes and Zoe Becker, looks at how the 2019 expansion of Medicaid in Maine affected childless adults on low incomes by comparing them to similar people in states that didn’t expand Medicaid.
Predictably, the paper finds that expansion increased insurance coverage. Making more people eligible for taxpayer-funded insurance is intended to do exactly that, and it should not be considered a substantive finding.
The paper goes beyond enrollment numbers to look at whether expansion increased access to care, finding that it did and that more people got checkups and fewer people delayed treatment because of cost concerns. Those are important measures, but they’re not the whole story. When policymakers are evaluating government programs, they should not judge success based on how many people are enrolled and how many services are provided, but rather on what those services accomplish, how much they cost, and whether taxpayers should be footing the bill.
The study does not establish better health
The study does not demonstrate that MaineCare expansion reduced mortality, improved the management of chronic disease, or made recipients physically or mentally healthier.
The researchers found significant health problems among childless low-income adults in the state, but they are careful to note that this study does not establish that MaineCare expansion solved these problems, or even reduced them. More checkups and screenings may provide more opportunities for diagnoses and treatment, but whether these visits actually improved health is an entirely different question that this study simply does not address.
The authors also found no increase in dental visits among their study population, but they note that the relatively recent implementation of comprehensive dental coverage for adults limits how much can be inferred from this finding.
The study’s results were hardly surprising. Expanding Medicaid increased the number of childless adults with health insurance, but the study does not provide evidence that those childless adults were healthier for having coverage. Supporters of Medicaid expansion may tout the study’s results as proof of the benefits of expansion, but expanding access to insured care is not the same thing as improving health.
Taxpayers deserve a place in the MaineCare debate
The study does not evaluate whether the expansion’s benefits justify its costs. It does not examine state budget tradeoffs or compare expansion with other ways to help people obtain care. Yet those are precisely the questions lawmakers must confront as Maine faces a significant budget shortfall.
As previously mentioned, Maine’s September 30 budget forecast projects a $1.085 billion General Fund structural gap for the 2028–2029 biennium, beginning July 1, 2027. The next governor and Legislature will have to bring projected spending into line with available revenue. MaineCare expansion should be part of that discussion.
Removing MaineCare expansion coverage for able-bodied adults is one way MPI’s 2026 Maine Policy Blueprint suggests saving General Fund money while protecting coverage for traditional eligibility groups, including children, seniors, pregnant women, and individuals with disabilities. According to MPI’s calculations, eliminating MaineCare expansion would save $55 million per year, or $110 million total over a two-year period of the projected budget shortfall.
According to MPI’s calculations, eliminating MaineCare expansion would save $55 million per year, or $110 million total over a two-year period of the projected budget shortfall.
Although preliminary, the estimated biennial savings from eliminating MaineCare expansion equal roughly one-tenth of the projected General Fund gap, a substantial amount that warrants serious consideration from lawmakers.
Supporters can point to increased coverage and improved access, but those findings do not excuse expansion from financial scrutiny. Before asking taxpayers to continue financing this commitment, lawmakers should demand evidence of what it accomplishes and whether those results justify the expense. Without weighing those benefits against their costs, this study falls short of making a convincing case for continued taxpayer funding of expansion.
MaineCare needs a defined mission
A fundamental question that is often overlooked in this debate is whether state government should be responsible for providing healthcare in the first place.
Providing healthcare to able-bodied, working-age adults is not an appropriate role for government. State policy should instead focus on making healthcare and private insurance more affordable and accessible through policies that encourage competition and increase choice.
Providing healthcare to able-bodied, working-age adults is not an appropriate role for government.
We should maintain a more narrowly focused safety net, and reserve that safety net for people who genuinely cannot take care of themselves. Children, pregnant women, vulnerable seniors, and people with disabilities should have priority over childless, able-bodied, working-age adults who can support themselves through gainful employment. Low income alone should not make a person eligible for open-ended state support.
In other words, MaineCare’s success shouldn’t be measured by how many people end up on MaineCare. A successful safety net protects those who need assistance the most, while encouraging and helping those who can become independent to move beyond the safety net. If we don’t establish a line beyond which people are expected to thrive without taxpayer support, success can never be achieved.
More enrollment is not enough
The success of the MaineCare expansion program should not hinge on enrollment numbers alone, especially given its cost to taxpayers. Availability of health insurance is only part of the equation in determining whether an expensive government program that expands access to healthcare is in the best interest of Maine residents, or whether its cost is too high for the benefits it provides.
The success of the MaineCare expansion program should not hinge on enrollment numbers alone, especially given its cost to taxpayers.
MaineCare expansion should be examined just like any other government expenditure. As lawmakers look at how to balance Maine’s budget, they should consider rolling back expansion, prioritize enrollment for the most vulnerable, and look to other solutions to make health insurance more affordable. Expansion may increase enrollment, but that obvious fact alone does not justify its continuation.