Mount Washington towers over one, and waves from the Gulf of Maine break along the coast of the other, but in many ways, Coos County, N.H., and Washington County, Maine, are much alike. Both counties are remote, rural and beautiful. Both are blessed with abundant natural resources and scenic beauty. And both counties struggle with high rates of poverty.

In 2012, 16 percent of Coos County’s non-elderly population had no health insurance, similar to Washington County’s 17 percent. Both counties had the highest rate of uninsured in their respective states.

But, in at least one respect, Coos and Washington counties are no longer mirror images.

In 2014, New Hampshire policymakers voted to accept $2.5 billion in federal health care funds to cover the uninsured. Some 1,460 low-income residents of Coos can now get regular health care. Another 1,390 purchased policies on the health insurance exchange, with tax credits to help make them affordable. These steps have combined to slash Coos County’s rate of uninsured residents.

While eligible Mainers have enthusiastically purchased coverage on the U.S. exchange, 1,650 Washington County residents, who would be eligible for coverage, remain uninsured because Maine’s governor has rejected federal health care funds. Despite five successive legislative votes in favor of accepting the funds, Gov. LePage vetoed each attempt, claiming in one veto letter that “Maine can do better.”

But we haven’t.

Those who remain uninsured in Washington County are too poor to qualify to buy insurance on the exchange. They remain at higher risk for late-stage cancer, undetected diabetes and high blood pressure. They are one car accident away from financial catastrophe.

While he mentioned the uninsured poor during the 2014 campaign, the governor has introduced no innovative state-level plan to address the problem.

Many Mainers eligible for coverage work at low-wage jobs with no benefits. Others are unemployed. The official unemployment rate remained nearly 8 percent in Washington County in December, while statewide and nationally unemployment is around 5 percent.

Most uninsured working Mainers who would qualify for coverage if the state accepted federal funds to expand Medicaid work in food service — in fast-food restaurants as waiters or as dishwashers. Several thousand more work in retail. A quarter of all job openings in Maine this fall were in food service and retail jobs. Of every 10 openings advertised, four were part-time.

There are proven ways to reverse the trend toward a low-wage and part-time workforce, particularly in rural America: Invest in workforce education. Invest in infrastructure, both the kind made from asphalt, concrete and steel, and the kind that improves communications and connects communities, businesses and people — especially in rural places — to the Internet.

Help rural areas achieve energy independence, by enacting policies that promote energy efficiency and local generation and distribution. Help rural areas level the playing field with multinational conglomerates by promoting local food and helping businesses access seed capital for expansions and start-ups.

These are some long-term strategies for the rural economy — but in the here and now, policymakers should not undermine the largest employers in many rural counties: rural hospitals.

But the governor’s refusal to accept health care funds has left Maine hospitals squeezed — unlike hospitals in states that have accepted the funds to cover the uninsured. Maine hospitals are still scrambling to serve high numbers of uninsured patients — and struggling with the accompanying financial burden of care that is not paid for, and with bad debt. This falls hardest on rural hospitals, where the rate of uninsured residents is higher.

Addressing the New Hampshire Senate on federal health care funding last year, Coos County Sen. Jeff Woodburn said: “Rural areas — 40 percent of the state is rural — need this action. The North Country is a proud, practical place — we know a good deal when we see one and this … is a good deal.”

The same is true for Maine’s rural counties — not only Washington, but Aroostook, Piscataquis, Hancock, Lincoln and Knox, where rates of people who are uninsured are higher than the state’s rate.

The comparison of Coos and Washington counties may not exactly represent the best of times and the worst of times, but it does illustrate the consequences for Maine as long as thousands remain uninsured, millions of dollars remain on the table, and federal health care funds remain a good deal.

Christy Daggett is a policy analyst at the Maine Center for Economic Policy.