‘I can’t remember the last time I saw a doctor. It’s probably been decades,” said a patient of mine who, for the purposes of protecting patient confidentiality I’ll call Jerry. This fifth generation Mainer came to my office to establish primary care with me earlier this year.

In exploring his medical, family and social histories I began to learn his story. The oldest of five originally from rural Maine, he is a former employee at a local mill and has been out of work the last six months amidst the COVID19 pandemic. With a 40-year history of tobacco and alcohol use, his nagging stomach pain began causing him to have difficulty swallowing. In beginning to work up his medical issues, we identified emphysema and cirrhosis, each a life-threatening illness affecting his lungs and liver, respectively. “It is what it is,” he tells me.

I wonder, though, what could have been if we’d seen him sooner, perhaps decades sooner? I also wonder what might be if MaineCare had not been expanded? In this turbulent election season­ and throughout the COVID19 pandemic, it is an understatement to say that we have a lot on our minds, as was this case for my patient. But if I can pivot your attention to the present judicial threat to the Affordable Care Act and MaineCare expansion in Maine, I want to remind you that health care is on the ballot on Nov. 3.

I work as a family and preventive medicine physician and serve as the medical director at the Central Maine Medical Center Family Medicine Residency program. Of the 7,000 patients we serve in Lewiston about 50 percent are enrolled on MaineCare, 25 percent are enrolled on Medicare, 20 percent are enrolled on commercial insurance with another 5 percent are uninsured. For our patients, MaineCare expansion has been a lifeline.

In delivering care to a socioeconomically diverse and underserved population, our patients make decisions every day between paying to put food on the table, childcare and medical bills while MaineCare expansion has helped allay some of the economic strain from the COVID19 pandemic. Newly enrolled patients on MaineCare frequently state that they haven’t seen a doctor in decades, and we welcome them into our patient-centered medical home delivering interdisciplinary primary care spanning behavioral healthcare, social work and pharmacy services. Too often, though, we uncover chronic diseases like coronary artery disease, chronic obstructive pulmonary disease (COPD), diabetes and cancer, which otherwise could have been addressed sooner or even prevented should they have had health insurance years prior.

Repeatedly over the last decade the Affordable Care Act has been attacked through the judicial system, most notably ending up in the Supreme Court in 2012 where Chief Justice Roberts’ vote to uphold the law assured the law’s healthcare protections. Through that decision, however, Medicaid expansion became optional for the states and it wasn’t until Gov. Mills implemented this in January 2019 that we’ve begun to see its benefits.

As of Sep. 3, the Maine Department of Health and Human Services notes that 61,539 people are currently enrolled through MaineCare expansion. They’ve accessed critical healthcare services including chronic disease management, mental healthcare, substance use treatment and preventive care. DHHS sites 4,775 people newly in treatment for diabetes, 28,370 newly accessing mental healthcare, 7,863 people newly accessing opioid use disorder treatment, 3,663 people newly being screened for breast cancer and 2,582 newly being screened for colorectal cancer. Just after this executive order was signed by Gov. Mills, the Portland Press Heraldr eported that Naomi Loss of Lisbon Falls commented “When I heard the news, it was such a huge sigh of relief. We have been putting off doctor’s visits because it’s just so expensive.”

The week after the coming November election, the Supreme Court is expected to hear the latest challenge to the Affordable Care Act. After the individual mandate was largely removed from the law through the Tax Cuts and Jobs Act of 2017, challenges have made their way to the Supreme Court where health insurance expanded to 20 million American by way of the Affordable Care Act is at risk, 12 million  through Medicaid expansion. If the law is invalidated and MaineCare expansion disappears, health care costs will rise and poor health outcomes will result, as was the case for my patient given decades of delayed health care.

With so much at stake in this election, please remember that healt hcare is on the state and national ballot on Nove. 3. Nearly 70,000 Mainers will see their health insurance disappear if the Affordable Care Act is nullified. The peace of mind, financial stability and access to health care for our friends, family and neighbors have been afforded will be gone.

For my patient, we continue to work together to manage his emphysema and cirrhosis. We take one small step each time we meet to share what motivates him, what concerns him and how best he can provide for his family. In reflecting back about his years absent primary care, he has mentioned to me, “I’m glad I got my foot in the door.” Me too.

Please vote to protect MaineCare expansion and elect candidates who will assure that healthcare is a human right.