AUGUSTA, Maine (AP) -- Expanding Medicaid in Maine would stimulate $350 million in economic activity, create more than 3,500 jobs and generate as much as $18 million in state and local taxes annually, according to a policy report released Tuesday.

But if Maine decides against expanding Medicaid, it stands to lose to other states the $256 million it could receive through the national health care law, while foregoing the other potential benefits, said Garrett Martin, executive director of the Maine Center for Economic Policy, a public policy research group that co-authored the report.

"Even for the thriftiest of Mainers, the case for accepting federal funds is strong," Martin said at a news conference with Maine Equal Justice Partners, a low-income advocacy group that also contributed to the report.

Their report came out a day after Gov. Paul LePage signaled he would be willing to discuss expansion of Medicaid if his plan to repay a lingering $484 million hospital debt is paid. The Republican governor has previously expressed reluctance to expand Medicaid, saying the federal government intends to back off full payment over time, leaving the state with obligations it cannot afford.

The Patient Protection and Affordable Care Act provides states with 100 percent of the funds needed to expand Medicaid services for three years, and 90 percent in the fourth year. The money is already appropriated, according to the report's authors, and there's no deadline for the state to sign on.

Majority legislative Democrats say expanding Medicaid, known in the state as MaineCare, is a priority. The report's authors said Maine cannot afford not to sign on.

Amy Madden, a family physician with the Belgrade Regional Health Center who represented the Maine Medical Association, said expansion would help people like one of her patients who lost his job because he was too ill with diabetes and heart disease to work, and couldn't afford treatment.

"Accepting these federal funds to provide coverage for nearly 70,000 of our neighbors is a once-in-a-lifetime opportunity that Maine cannot afford to turn down," Madden said.

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Her comments were echoed by Wiscasset restaurant owner Cheryl Rust, who said her business has struggled to keep up with rising costs to keep its employees insured. Rust said expanding Medicaid will boost productivity by eliminating lost work time and lowering a cost shift for providing care to Maine's roughly 128,000 uninsured.

"This opportunity provides us, as a state, as a community, a chance to do the right thing," Rust said.

The report said federal funding would stimulate $350 million in economic activity in 2016 and create 3,100 jobs as health care providers hire workers, who would spend their money at local businesses and pay $16 million to $18 million in state and local taxes annually.

Maine's most rural counties, where higher percentages of the population stand to gain health coverage, would see the greatest benefit from Medicaid expansion, according to the report. It points to Washington County, where 13.2 percent of the adults under 65 would gain coverage, compared to more urban Cumberland County, where 6.6 percent would be covered.