June 20, 2018
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Gutting Maine’s health care system

By Dr. Erik Steele

In a desperate effort to deal with rising health care costs, Maine is in the process of hauling parts of its health care system up on a pole and gutting it like a dead deer. Its governor proposed last week to bag health insurance for 28,000 poor Mainers as part of his efforts to close a state budget deficit. Republicans in the Legislature are ramming through the repeal of state insurance rules that protect its small hospitals and sicker residents from potentially ruinous competition in an effort to make commercial health insurance more affordable for Maine businesses.

It’s tempting to blame Maine Republicans for this, but we are all to blame. First, we have failed to force our political leaders to do what Massachusetts has now done — develop a state health insurance system that covers every resident of the state. Without that foundational commitment, throwing people off insurance rolls is an acceptable way of cutting government and business expenses.

Second, we have all failed to take the tough steps necessary to rein in health care costs in Maine. As a result, we have an expensive health care system we cannot afford, and political and business leaders doing desperate things to control those costs. Yes, they could make other choices (and should — a 15 percent reduction in the size of the governor’s proposed tax cuts, by my calculation, would pay for the Medicaid health insurance for those 28,000 Mainers, for example). At the end of the day, however, the ruinous cost of health care is the real culprit, and we have all done our part to let it run amok.

Without real change, subsequent years will bring more of the same. Buying health insurance out of state, or forcing patients to travel for lower cost health services, may reduce health insurance premium costs in the short term, but not for long term because the problem of health costs is not addressed by this approach. Tossing more Mainers off Medicaid will help this state budget, but without control of health care costs, more will just have to be tossed off next budget. We are chasing our tail again, hoping for a different result.

The human price for this year’s efforts to control costs will be particularly high. Cutting off 28,000 people from insurance almost certainly will kill a few of them and sicken others; numerous studies have found that the uninsured are more likely to die from preventable causes, and develop more preventable complications of chronic disease. For those reasons if no others, the state’s health care professionals should be opposing such cuts, and demanding to know the health status of those the state proposes to deprive of health care insurance and care.

(And don’t tell me it’s reasonable to cut Maine’s Medicaid rolls because Maine has proportionately more residents on Medicaid than many other states. Our moral lapse of leaving fellow citizens uninsured cannot be justified on the grounds that moral lapses elsewhere are worse.)

Cutting off the current rules that protect Maine’s health insurance market from increased competition could shred the financial stability of Maine’s rural hospitals, which provide much of the care — family care, hospital care, emergency care, etc. — for most of rural Maine. Those hospitals lose money providing that kind of care, and make up those losses in part by charging more for labs, X-rays and surgeries than some competitors. The insurance rule changes in LD 1333 almost certainly will mean loss of some of that profitable business, threatening the ability of those hospitals to hold Maine’s rural health care delivery system together.


That Maine’s Republican legislators would pass such a bill without first protecting this rural health care safety net is profoundly shortsighted, but not surprising; they are so desperate to reduce commercial health insurance costs they will try anything. And if this guts the rural health care system for hundreds of thousands of Mainers, we should not be surprised; if care is not guaranteed for 28,000 of Maine’s most vulnerable residents, it is not guaranteed for any of us.

We are all collectively responsible — and irresponsible — for allowing that to be the case. Shame on us.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

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