The Maine Legislature has passed legislation expanding Maine Care (Maine’s version of Medicaid) five times. An ideologically driven governor has vetoed each of these enactments. A similarly driven House or Senate has narrowly sustained these vetoes.

Maine has lost hundreds of millions of federal support dollars that would have provided meaningful health insurance to 70,000 Mainers.

Dollars that would have flowed into every corner of the state, especially rural hospitals, physicians, and related health-care providers.

Dollars that would have reduced dependence on high-cost emergency-room services made necessary when uninsured patients in dire straits are transported to the nearest emergency-care facility.

These vetoes are both mean-spirited and economically irrational.

Thirty-one states (red states and blue states) and the District of Columbia have put aside ideological claptrap and participate in the Medicaid expansion made possible by the Affordable Care Act. They can’t all be wrong.

The 19 states (Maine included) that have opted out are a mixture of relatively poor and better-off states; almost all are red states, but all have ignored the human health-care needs of their elderly and poor citizens – and all 19 have flunked Economics 101.

Given these realities, the only way forward in Maine is by a citizens initiative: legislation that, if passed, the governor is constitutionally prevented from vetoing.

This initiative is Question 2 on the Nov. 7 state ballot. It is a short document that amends existing Maine Care legislation. There is nothing new or radical in the document. It borrows the best language in one or another of the five enactments that were passed by the Legislature, but vetoed by the governor.

More importantly, although Maine has irrevocably lost the three years of start-up full federal funding for participating in this Medicaid expansion, we would qualify (if the initiative passes) for the 90 percent ongoing federal funding for expanding health insurance to the 70,000 Mainers who would be eligible for this insurance coverage.

No other federal/state cost-sharing program – including highways, schools, energy efficiency, or other social program – is as generous.

Mainers send their tax dollars to Washington fully expecting that elected state officials will participate in programs that bring federal assistance dollars back to the state to offset the costs of essential programs. Health insurance in today’s world is essential. It is often the difference between life and death. It surely improves the quality of life.

When the feds are willing to reimburse 90 cents of every dollar spent to provide an additional 70,000 Mainers with meaningful health insurance (not merely high-deductible or catastrophic coverage) we are fools not to take them up on it.

In short, LePage’s obstinacy has already cost the state hundreds of millions of dollars; he has been penny wise and pound foolish; he has impaired the quality of life, and life itself, for tens of thousands of Mainers.

Voting yes on Question 2 will bring this to an end.

In the recent national debates with respect to Republican efforts to repeal and replace the ACA, Maine’s Senators held firm. Sen. Susan Collins’ vote was critical; she repeatedly made the point that we need to expand health-insurance coverage, not shrink it. That’s the truth in a nutshell.

This is the point that national and state hospital associations, the American Medical Association, nursing associations, and health-care economists have been making for years: expanding health-insurance coverage is not only the right thing to do, it is economically the best single step we could take – as a nation and as a state – to moderate spiraling health care costs.

The time for Mainers to act is now, by voting yes on Question 2.

Orlando Delogu of Portland is emeritus professor of law at the University of Maine School of Law and a longtime public policy consultant to federal, state, and local government agencies and officials. He can be reached at orlandodelogu@maine.rr.com.