Much has been written about the upcoming Maine referendum on Medicaid expansion on the Nov. 7 ballot (statewide Question 2). The issues are complicated, so it’s important to address the confusion and surrounding myths:

• Myth No. 1: There aren’t many people who would be affected by this vote.

Reality: Over 70,000 Mainers would directly benefit from Medicaid expansion, giving them access to needed and previously unaffordable coverage and services — no small number. These are people who earn up to 138 percent of the federal poverty limit — i.e., they have an annual income of just under $16,000 for a single person, or $28,000 for a family of three.

These are our friends, our neighbors and our relatives — and often those who we routinely count on to support our daily lives, such as wait staff, convenience store attendants, cooks and housekeepers, many of whom can barely get by on minimum wage.

• Myth No. 2: We don’t need Medicaid expansion because “able-bodied” people can get health insurance through their job, or should buy it on the health insurance exchange.

Reality: Medicaid expansion will support the hardworking poor, many of whom have jobs that do not offer health insurance and/or simply do not make enough to afford it. While the Affordable Care Act offers an opportunity to buy insurance on the exchange, many simply cannot afford the extra costs despite ACA subsidies, an understandable reality when thinking about supporting a family of three on a gross income of $28,000 a year.

For those who can afford to buy insurance, many are overwhelmed by the deductibles and co-payments for health care services. While meaningful work should be encouraged, the reality is that many working Mainers simply cannot afford health insurance coverage, and studies in states that have expanded Medicaid show that coverage helps people to work.

• Myth No. 3: We don’t need to expand Medicaid because people without health insurance can access health care through federally qualified health centers and Maine’s hospitals.

Reality: Many studies show that people without health insurance have worse health outcomes than those with insurance. Not having insurance significantly limits access to routine and preventive health care services and has a strong impact on health.

While it is true that federally qualified health centers and hospitals are required to provide care to the uninsured, those clinics are intended to serve as a “safety net” for individuals unable to get insurance, often for acute or emergency care, but generally not for ongoing care of chronic or complex conditions such as cancer treatment. Their existence is not a reason to withhold insurance from people needing care.

It is neither reasonable, moral nor viable from a business perspective to expect that safety net clinics can provide unlimited amounts of charity care, especially in Maine, where many small and rural hospitals already face unsustainable losses that are threatening their survival.

• Myth No. 4: We need to choose between expanding Medicaid and reducing the waiting list of disabled people needing custodial services support.

Reality: Expanding Medicaid won’t create longer waiting lists, and pitting people with one unmet need against another is a tired tactic. While this argument has repeatedly been put forward by the current administration, it falsely implies that if Maine does not expand Medicaid, we will somehow apply the “saved” dollars to reducing the waiting list for services for the disabled. While it is true that Maine as a state should find better ways to increase funding for custodial care, this is a separate issue, and is not directly linked to Medicaid expansion.

• Myth No. 5: Maine cannot afford to expand Medicaid.

Reality: Maine cannot afford not to expand Medicaid. Limiting access to essential health care services by the poorest is both immoral and financially irresponsible. Expansion offers a chance for Maine to receive at least 90 percent reimbursement from the federal government for most people eligible for Medicaid expansion, funds that 31 other states are benefiting from. (In other words, our federal taxes are supporting Medicaid expansion in 31 other states – but not our own!)

States also bear the costs of the uninsured in many other ways. Hospitals cost-shift the burden of uncompensated care through higher prices and commercial insurance rates. We pay higher costs when people without insurance eventually get treated for complications of delayed or missed care. And we pay a myriad of social and economic costs for those who suffer from addiction and cannot get desperately needed treatment services — services that other states are providing through Medicaid expansion.

The issues admittedly are complicated — but it’s time to clear the air and do the right thing for Mainers: Vote “yes” on statewide Question 2.

Lisa Letourneau, M.D., MPH, is a resident of Portland.