As a conservative, I am deeply concerned by the continued spending habits at all levels of government, including the large expenditure required for MaineCare programs, and the increasing reliance on government assistance by more people here in Maine.

At the same time, I am also a realist who believes in analysis and facts to make the best decisions, and I recently came to the conclusion the expansion of MaineCare might prove to be the best solution for all Mainers.

More than 35,000 of the 70,000 lives to be insured could be covered by the Affordable Care Act (Obamacare), but enrolling them would require granting them up to as a 90 percent subsidy, based on their income levels. That subsidy will come in the form of increased taxes to all working people.

The cost per person is far less under MaineCare ($2,126 per adult, $3,879 per child) than the cost of Obamacare subsidies, which could be higher unless choosing a plan with minimal coverage. And there is no guarantee that people with financial difficulties would choose to keep that health insurance in tough times.

MaineCare is also better for Maine’s economy.

Under Obamacare, there would be the premium payment plus significant deductible, coinsurance and/or copays — far exceeding the patient share under MaineCare. That lower patient cost is money kept in the individual’s pocket which can be used for other household expenses and thus putting money back into the local economy.

In addition, MaineCare will provide some services, such as case management, not necessarily found under traditional insurance coverage but most helpful to those with limited resources.

This leads me to consider the cost of not insuring people’s health.

Not receiving preventative care and screenings could lead to larger problems later for undiagnosed or untreated medical conditions.

MaineCare is often the payor of last resort, thus we could end up with higher costs for the same enrollees later when they can no longer support themselves by working and require more intensive care.

I have said that no one dies from lack of health insurance, but it does become a factor when deciding what one can afford for care. That is especially true with behavioral health issues that, when left untreated, can manifest into disastrous results for all of us.

That being said, expansion should not occur until a thorough review of MaineCare administration, benefits package and all federal and state regulations is undertaken to ensure the cost and breadth of services are no greater than can be afforded or required.

Such a review would likely cost more than $1 million and take 12-18 months to fully analyze and report. Health care providers must be willing to consider changes to how they care for the patients and how they are reimbursed.

The Legislature would then be asked to implement changes as needed.

Lastly, MaineCare expansion should not be considered a stepping stone to other expanded social services and greater welfare eligibility, but, instead, be looked at a gateway to health insurance to assist those trying to get ahead.

Don’t be fooled by those who claim thousands of new jobs, because either the new insured never got services or never used charitable care and free services. If 3,000 jobs could be created for 70,000 newly insured, it assumes none of them got health care. You can’t claim new jobs while also claiming a reduction in charitable care spending.

And let’s not call the full funding over the next three years “federal money that’s free,” as it’s simply our tax dollars now and in the future being used to fund the expansion.

Let us not forget that the entire argument is not about health care but, rather, who pays for it.

The Legislature needs to make a reformed MaineCare a top priority. Legislators will need the intestinal fortitude to make changes in benefits and potentially small cuts in reimbursement to save what otherwise might become an albatross hanging over all our heads. That could include limiting some services to certain classes of need, such as transportation.

Consumers must be willing to take responsibility by following the rules of the program and participate in specifically identified services, such as smoking cessation, weight loss clinics or other targeted programs. People must be willing to take some responsibility for managing their health or that of their children, and removed from the program should they not follow the requirements.

With restraint and compassion we can lead the way. Perhaps it is time for that change, but only if all parties have the will to compromise and advance in an educated manner.

Robert Reed of Lewiston has worked in health care finance and reimbursement for more than 25 years, including primary rural care, behavioral health and long-term care. In addition he serves on the DHHS/MaineCare Provider Advisory and Technical Advisory groups.