The expansion of Medicaid in Maine was billed as a way to get health coverage to more vulnerable residents. Nearly four years later, it’s living up to that promise.

Mainers for Health Care rally for Medicaid expansion in February 2018. Federal policies under which millions of Americans get Medicaid will expire next year without action by Congress. Robert. F. Bukaty/Associated Press, File

Now, it’s up to Congress to protect those benefits, as well as others that have led to a historic, healthy drop in the number of uninsured Americans.

According to a new federal report, the number of uninsured low-income Mainers fell nearly 5 percentage points, from 21.3 percent to 16.5 percent, between 2018 and 2020.

The drop came following Gov. Mills’ executive order to expand Medicaid – or MaineCare, as it’s called here – which she signed on her first day in office, Jan. 3, 2019.

Expansion was enabled under the Affordable Care Act, and Maine voters had approved it at the polls in 2017. But its implementation was blocked by then-Gov. Paul LePage, who was a longtime opponent of the measure, saying it would threaten to put the state in “red ink.”

As we near the end of Mills’ first term, the state’s finances are more than fine.

And as of late last year, more than 80,000 Mainers had enrolled as part of Medicaid expansion, giving Maine the third-highest drop in uninsured low-income residents of any state in that time period.

The same is happening across the country, as other holdouts from Medicaid expansion finally put the program in place. The federal public health emergency rolled out in response to COVID-19 blocked states from dropping anyone off Medicaid, too, keeping the rolls high.

Additionally, the American Rescue Plan passed last year by Congress included enhanced subsidies for coverage through the ACA exchanges, helping to fuel record enrollment.

Together, all of it put the national uninsured rate at an all-time low: 8 percent as the first quarter of the year, with 5.2 million Americans gaining coverage since 2020.

What’s more, the rate of uninsured children, which increased in 2019 and 2020, fell too.

The uninsured rate, one of the main targets of the ACA, was around 15 percent when that federal legislation passed in 2010. Now it’s almost half that.

That’s a lot more people who are enjoying the benefits of health coverage. Access to Medicaid expansion, federal researchers found, was associated with lower out-of-pocket spending and improvements in primary and preventative care.

That’s the good news. The bad news is, millions of them could lose coverage if Congress doesn’t act.

The enhanced subsidies run out at the end of the year. According to a report from the Robert Wood Johnson Foundation, that could force 3 million people to lose coverage. Others will see price hikes, or opt to narrow their coverage in order to save money.

The federal public health emergency also runs out this year, and states will again be allowed to determine who is eligible for Medicaid– and who isn’t. The Kaiser Family Foundation estimates the change will cause 13 percent of enrollees to lose coverage. That’s millions of Americans.

Congress needs to extend the ACA subsidies past this year, which would also help any Medicaid recipients who get dropped from the program once the public health emergency lapses. States should do whatever they can to help people navigate their health coverage options, so that they don’t lose benefits they’re entitled to.

A decade ago, the number of uninsured Americans was a five-alarm crisis. Since then, millions have gained the benefits of health coverage. It’s no time to go back now.