Clarification: St. Mary’s was denied a certificate of need for an operating room expansion; the hospital’s emergency care expansion was previously approved. This was an editorial writer’s error.

Despite concerns about efficiency and missed collaborative opportunities, emergency room expansions at St. Mary’s and Central Maine Medical Center might be unavoidable, if other stated health care goals are to be achieved.

Last week, both Lewiston hospitals (plus Eastern Maine Medical Center) were preliminarily denied Certificates of Need for the expansions. Now, the hospitals have until June 11 to re-submit their cases to the Certificate of Need Unit of the Department of Health and Human Services.

The unit must carefully re-consider these proposals; Maine’s health care goals could depend on them.

While current use (CMMC, for example, says its ER was built for 25,000 annual patients, and served 53,000 in its last full fiscal year) drives the argument for expansions, greater access to emergency care is a growing, definitive need for Maine’s health care landscape.

This state boasts one of the lowest uninsured rates in the nation, which is a testament to programs and policies specifically aimed at enhancing coverage. Most notable among these are Medicaid eligibility expansions and the never-controversy-free Dirigo Health.

Regardless of opinions on these programs, it is inarguable that more Mainers have access to health insurance.

More health insurance, however, does not translate into more health care. Despite coverage, there remains in Maine (and in other rural states) a shortage of medical professionals, especially family practitioners and specialists.

In February, the Maine Hospital Association counted 200 physician vacancies across the state. This desperate scenario is one reason Tufts University and Maine Medical Center in Portland are uniting to bring third- and fourth-year medical students to practice in Maine.

“It is a unique approach to find a solution for what is becoming a national crisis: a lack of physicians, specifically primary care physicians, and especially in rural areas,” said Vincent Conti, the president of Maine Med, in announcing the partnership earlier this year.

There is a link between a declining rate of uninsured and an increased demand for physicians. Massachusetts, in a study released Tuesday, has found its aggressive, successful efforts to reduce the uninsured have made emergency room visits, for non-urgent maladies, rise.

In its story, the New York Times said the study supported anecdotal evidence from Massachusetts physicians that the influx of patients has caused delays in appointments and an increase in reports of patients unable to secure time with doctors.

This is the rub: while covering the uninsured is possible through policy, conjuring the requisite medical personnel to treat them is not. While the expansions at St. Mary’s and CMMC draw the skepticism of state regulators for efficiency and collaborative reasons, these concerns might be stretching for an ideal, rather than recognizing reality.

With Maine making headway in covering the uninsured, the subsequent demand for care and physician shortage make strong arguments for expanding emergency care.