June 25, 2018
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A perfect storm for rural Maine

By Nancy Cummings and Joe Ditre, Special to the BDN

The cuts in the administration’s supplemental budget proposal are the latest in a series of actions that will have a devastating impact on health care in Maine. These cuts will shred the safety net in our state. As if that weren’t bad enough the impact of these cuts goes way beyond the people who will be left without coverage, they impact every one of us.

Everyone in the state will suffer, as 65,000-plus people lose coverage their only alternative will be to seek care in emergency rooms — often without the means to pay. This represents a 50 percent increase in the number of uninsured in our state. Very quickly those with private insurance throughout the state will see their rates go up as providers seek to recoup their expenditures for this uncompensated care.

Much is being written about these impacts on specific groups — children, seniors, etc., all of whom will suffer if these proposals are enacted. In this space we want to focus on how rural Maine will be affected. When taken in conjunction with two private insurance regulation changes passed in the last legislative session as part of LD 1333 (now Maine Law Chapter 90) these new budget changes have the potential to decimate rural health care in our state.

In the film “The Perfect Storm,” three separate weather fronts combined to create a monster storm larger than any individual piece. That’s the situation that will arise if these budget proposals pass. In Maine’s version of this movie, the three storm fronts that are converging are using where you live to set higher premium rates; elimination of the requirement on insurance companies that services be available in your community; and the drastic increase in the number of uninsured resulting from the current proposed budget cuts. Let’s take a look at each storm individually.

Allowing insurers to charge more in premium based on where you live: Before Chapter 90, private insurance rates did not vary significantly based on where you lived. That is no longer the case. As a separate rate setting factor, rates now are being set higher for those in rural Maine.

The simple fact is that costs are higher in rural areas because there are fewer people over whom to spread costs. In the past the costs were spread throughout the state, now rural counties must bear the added expense. The result is higher premiums for people living there. Higher premiums means there will be some people not able to pay the increased rates so it means people dropping coverage and more uninsured people in rural areas.

The elimination of the requirement on insurers to make sure care is available close to you: Before Chapter 90, health insurance was required to cover providers within a certain distance of your home; standards were set for both doctors and hospitals. Now those requirements have been eliminated. That means your health insurance can “encourage” you to use far off providers simply because the insurance company gets a better rate.

This is not the place to debate if that’s a good idea or not, but the impact is undeniable. Insurers will steer paying customers away from small rural providers to large hospitals in the major cities, resulting in a reduction of the number of paying customers to rural providers.

The current proposal to cut coverage outright to over 65,000 Mainers: If these proposals pass, the number of uninsured in our state will increase by 50 percent. Just because these people are not covered does not mean they won’t need heath care services. It just means the services won’t be paid for. Without coverage they will have no option but to go to the emergency room — straining already strained charity and free care programs.

We’ve seen that these three separate changes to our health care system in isolation would have horrific effects. As the storm builds and the three fronts join together the devastation will result in Maine losing many of our rural health care providers. Without those paying customers, doctors and hospitals will be forced to close their doors and insurance premiums will go up as costs are shifted onto individuals and small businesses (who are already struggling to remain insured).

Nancy M. Cummings, MD is president of the Maine Medical Association. Joseph P. Ditre, Esq. is executive director of Consumers for Affordable Health Care.

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