Gov. Baldacci’s goal of creating universal health care coverage in Maine suffered a significant setback last week when a planned expansion of MaineCare was stopped.

Baldacci’s decision follows spending constraints imposed by the federal government and a higher rate of enrollment in MaineCare, the state’s version of Medicaid, than expected.

By most measures, Maine has lenient eligibility requirements for MaineCare. The goal is to expand insurance coverage to more of the approximately 138,000 state residents without health coverage.

In 2002, the state applied for a waiver to provide coverage to childless adults with incomes below the poverty line – about $9,500 a year. The federal government, which matches state Medicaid spending with $2 for every $1 spent, approved the expansion, but placed a cap on the amount it would spend. Maine had expected to enroll 15,000 people, but 24,000 signed up.

MaineCare is everybody’s favorite kicking boy these days, but it also is the foundation of the Dirigo Health plan. While most families in Maine receive their health-care coverage through their employers, those numbers have steadily declined as manufacturing jobs, which typically provided health-care benefits, have been replaced with service-sector jobs.

Last year, at some point 308,000 Mainers participated in MaineCare. Without the state-federal program, these people would have had no insurance coverage. After the waiver allowing childless adults into MaineCare, free care provided by the state’s hospitals declined sharply. Free care, of course, isn’t free since those costs get passed along to others who have insurance.

Expansion of MaineCare to low-income workers helps contain overall health costs by improving early treatment of chronic diseases and by increasing preventative and maintenance care.

The governor’s office has said that the enrollment freeze is a temporary solution while negotiations for more federal funding continue. But we are less optimistic.

The Bush administration has slated Medicaid for serious budget cuts – $45 billion over the next 10 years. Many Maine conservatives have long made reducing MaineCare enrollment a top priority. With the state’s budget gap pegged at around $730 million for the next biennium, efforts to expand MaineCare’s numbers will face even tougher opposition.

If the promises of Dirigo Health are to be met, MaineCare will have to provide a safety net for individuals whose income hovers around the poverty line and can’t afford market-based solutions to health-care coverage.