Across Maine’s vast and deeply rural Second Congressional District, the nearest hospital can be an hour or more down winding, snow-covered roads. For families in towns like Fort Kent, Lincoln, or Dover-Foxcroft, that hospital is not just a place for emergencies—it is the reason a grandmother can see a doctor for her heart condition without driving across the state, why a pregnant mother can deliver her baby close to home, and why a logger with a crushed hand can get care before it becomes a catastrophe. So when former Governor Paul LePage steps onto the campaign trail and tells voters that Medicaid expansion has hurt rural hospitals, he is telling a story that contradicts the lived experience of many Mainers and the data that follows federal health care dollars across the state. During a May radio interview, LePage, now the Republican nominee for Maine’s 2nd Congressional District, repeated his long-held criticism of expansion and suggested it had damaged the financial health of rural hospitals. But Dr. Noah Nesin, a family physician in Glenburn, responded in no uncertain terms. “It’s inarguable that Medicaid expansion helped rural hospitals and health access,” he told the Maine Independent. “Compared to where we would be without it, it’s dramatic.” In a district where poverty and geographic isolation make reliable health care a matter of survival, the question of whether to protect or dismantle Medicaid expansion is not an abstract policy debate—it is about whether rural Maine will continue to exist as a place where people can live and grow old.
The evidence behind Dr. Nesin’s words is not difficult to find, and it is written in the budgets and staffing plans of rural hospitals that were struggling long before the Affordable Care Act expanded Medicaid. Before expansion, hospitals in Maine frequently absorbed the cost of caring for uninsured patients who delayed treatment until their conditions were serious and expensive. Those unpaid bills piled up, forcing administrators to cut services, lay off staff, and sometimes close departments entirely. When Maine finally expanded Medicaid under the Affordable Care Act, hundreds of millions of federal dollars began flowing into the state’s health care system, covering people who had previously fallen into the gap between poverty and affordability. That money meant fewer uncompensated emergency room visits, more reimbursements for rural providers, and the ability to offer services like behavioral health care, addiction treatment, and preventive screenings that keep people out of the hospital in the first place. For small hospitals operating on razor-thin margins, the difference was not just helpful—it was existential. Nesin, who has spent his career caring for patients in rural Maine, did not hedge when he described the impact. He argued that without expansion, the situation would be “dramatic” in the worst possible way. Rural hospitals would have been forced to make impossible choices: shutting down maternity wards, eliminating outpatient clinics, or closing their doors altogether. Instead, expansion gave many communities a fighting chance to keep their health care local, to keep their emergency rooms open, and to keep their nurses and doctors employed in the towns where they grew up. So when LePage claims expansion hurt rural hospitals, he is not just minimizing that progress—he is denying the evidence that rural providers themselves have seen in their own balance sheets and waiting rooms.
LePage’s latest attack on Medicaid expansion is consistent with a career spent fighting the policy at every turn. As governor for eight years, he vetoed multiple bills that would have expanded Medicaid, even after the federal government promised to cover the majority of the cost and even as hospital administrators and doctors pleaded with him to accept the funds. When Maine voters in 2017 approved a referendum to expand Medicaid by a clear majority, LePage still refused to implement it, delaying access to care for tens of thousands of low-income Mainers. He left office in 2019, and it was only after Governor Janet Mills took office that the expansion was finally put into effect. The delay had real human consequences. Parents waited years for dental care. People with untreated mental illness went without medication. Rural residents postponed screenings for cancer until the disease had already spread. By the time expansion actually began, hospitals in the state had already been stretched thin, and the need was greater than ever. Yet LePage continues to frame expansion as a burden, and he has gone a step further by defending the federal Medicaid cuts signed into law by President Donald Trump in 2025. During an August 2025 interview, LePage said he would have voted for the legislation, praising its tax cuts and describing the package as “the greatest thing that can happen to the Maine people, particularly in CD2, which is rural and poor.” It is a remarkable statement, because those very cuts are expected to hit rural and poor communities the hardest, and they come at a moment when Maine’s health care system is already vulnerable.
The numbers paint a dark picture of what these cuts would mean. Protect Our Care Maine, an advocacy group that tracks health care policy, projected that the 2025 federal Medicaid cuts will cost Maine hospitals $1.5 billion over a decade. That is not a distant figure abstractly disappearing into a government budget—it is the equivalent of losing entire departments, health care jobs, and even whole facilities in the communities that can least afford to lose them. The group reported that 20 health care providers in the state have already closed, announced service reductions, or are at risk of doing so. Dr. Nesin echoed the danger, saying Maine could lose $4 billion in federal funding over ten years. For rural hospitals, the consequences are particularly brutal because they have less private insurance revenue to fall back on. Their patients are older, poorer, and more likely to rely on Medicare and Medicaid. When revenue declines, administrators must make painful decisions: stop offering lab services, reduce ambulance coverage, cut positions, or close a wing. Those decisions ripple through the community in ways that go beyond medicine. A hospital is often the largest employer in a rural town, and when it shrinks, the local pharmacy loses customers, the diner loses regulars, and families looking for a place to settle decide to leave. The tax cuts LePage celebrated do not build maternity wards or keep rural ambulances running—they are paid for, in part, by taking away the very health care dollars that keep rural Maine alive. And LePage’s repeated praise of those cuts, combined with his history of obstructing expansion, suggests that as a congressman he would not just accept further damage to rural hospitals but actively support it.
This November’s election in Maine’s 2nd Congressional District is shaping up to be a stark choice between two very different visions for the future of rural health care. LePage is running against Democrat Matt Dunlap, Maine’s former secretary of state and current state auditor, for the open seat. Dunlap has put health care at the center of his campaign, and he has won the endorsement of National Nurses United, the largest union of registered nurses in the country. The union’s endorsement, announced in April, highlighted Dunlap’s support for safe staffing ratios, workers’ organizing rights, and guaranteed health care for all. For nurses, these are not political slogans—they are the daily conditions that determine whether a patient in a rural emergency room gets a nurse in time, whether a CNA can afford to stay in the profession, and whether families can trust that their loved ones will be treated with dignity. Dunlap has said he would support Medicare for All and safe staffing levels in Congress, a position that directly addresses the structural problems that LePage has ignored or made worse. The contrast could not be sharper. On one side is a candidate who spent years vetoing expanded care, delaying its implementation, and celebrating cuts that strip billions from rural hospitals. On the other is a candidate who has pledged to fight for the health of working people and to make sure that where someone is born in Maine does not determine whether they can see a doctor. In a district where every vote matters and where the margins of life and death are often measured in miles, that contrast matters enormously.
For the people of the Second District, this is not a distant fight between politicians in Washington. It is the story of a daughter driving her father to the hospital after he slips on ice, wondering if the doors will still be open when she arrives. It is the story of teachers and mill workers who postponed care because they did not have insurance, and who now worry that the progress made over the last few years could be undone. It is the story of nurses who stay late because the hospital across the county shut down, and of doctors like Noah Nesin who see the evidence every day and refuse to let it be erased by political talking points. LePage may call Medicaid expansion a harm, but the people who live in rural Maine know better. They know that expansion brought resources, dignity, and hope to communities that had been left behind. They know that the federal cuts he supports will only deepen the crisis, forcing more closures, more layoffs, and more desperate, costly visits to distant emergency rooms. The choice in November is not simply between two candidates or two parties. It is a choice about whether rural communities deserve to survive, whether health care is a public good or a privilege for those who can afford it, and whether Maine’s Second Congressional District will be represented by someone who listens to hospitals, nurses, and patients—or by someone who has spent a career fighting them. As the snow begins to fall across northern Maine again, the stakes could not be higher. The future of rural health care, and with it the future of rural Maine itself, is in the hands of the voters.