While other states worked to provide more people with health insurance, LePage worked to take health insurance away, disproportionately impacting rural Maine. Beyond rejecting federal funds to expand Medicaid, he lowered eligibility levels so that many Mainers struggling with low income no longer qualified. Even a single parent earning just $16,000 a year was considered too wealthy. Older, rural Mainers faced higher health insurance costs as a result of changes to insurance laws spearheaded by LePage. Older Mainers with fixed incomes were targeted, too — the popular “Drugs for the Elderly” program was one of the first LePage slashed, leaving thousands of older Mainers unable to afford their medications. LePage also opposed efforts to expand reproductive care through Medicaid and in 2013 defunded family planning services by $400,000, despite research showing that every $1 of public family planning funding saves almost $5 in Medicaid costs. At a time when millions of Americans were gaining access to health care through the Affordable Care Act (ACA), Maine was the only state to not increase its share of people with health care coverage — by the end of LePage’s term, 3,600 fewer children were insured than before he took office. When Maine voters rejected LePage’s approach and used the referendum process to force Medicaid expansion in 2017, LePage refused to implement the law, even when ordered to by courts.