Delivering affordable, high-quality health care is challenging in any setting these days. Across our industry, providers are challenged with deploying the most current technology and care models, recruiting talented staff and making it all work within a payment system often at odds with delivering the best care.
These difficulties are further magnified in rural communities, particularly those that are economically stressed.
It’s alarming that these same rural areas stand to lose the most, should the Affordable Care Act be repealed without an adequate replacement. All Americans have a stake in this debate, but the numbers make clear that those stakes are higher in places such as rural Maine. Knox and Hancock counties, for example, have a higher percentage of their residents enrolled on the federal exchange as more urban counties such as Cumberland and Penobscot.
During the seven years since it went into law, the Affordable Care Act has provided relief to thousands of moderate and low-income Mainers by helping them afford health care coverage. It also has promoted important progress in improving population health, value-based purchasing and building a primary care foundation.
That being said, the Affordable Care Act is far from perfect. Its individual insurance market doesn’t do enough to bring younger, healthier people into the coverage pool, making coverage more expensive and raising issues of its long-term sustainability. And when Medicaid expansion became optional for states, this created a gap in insurance access for the poor.
These can be refined, but not without bipartisan collaboration. Passed in 2010 with only the votes of Democrats, the Affordable Care Act quickly became a source of controversy between Republicans and Democrats. This polarization has fueled divisive rhetoric at the expense of necessary compromise and refinement.
If Congress continues its path toward repealing and replacing the Affordable Care Act, we strongly urge that any replacement must provide access to affordable, high-quality health insurance for low-and moderate-income people, while realigning health care financing to support improved value.
Neither the plan passed by the U.S. House of Representatives in May nor the one released by the U.S. Senate leadership on Thursday meets this test. The plan will reduce the number of people who have coverage, and as Cynthia Cox with the Kaiser Family Foundation said, “Rural residents will be the hardest hit.” The plan reduces federal health care dollars available today that help make premiums affordable and, in some states, expand Medicaid.
There’s a lot at stake. Many of Maine’s hospitals and health systems are already struggling with financial losses as they deal with a changing industry landscape and the reimbursement cuts imposed by Medicare and Medicaid.
Repealing the Affordable Care Act without a suitable replacement could be a tipping point for many health care providers, raising serious issues of access to care for thousands of Mainers of all income levels.
We urge our representatives in Washington to “first, do no harm.”
Ideally, the two political parties will find ways to work together to find a solution, but the heated rhetoric makes that difficult. We are encouraged by the leadership of Maine’s senators, Angus King and Susan Collins, who have voiced concern about the negative impact that repealing the Affordable Care Act would have on Maine residents. And Collins has taken the important step of sponsoring legislation that clearly aims to forge a constructive compromise.
We recognize the politics of this debate are difficult and urge Maine’s delegation to put patients before politics. We believe our delegation is poised to be a leading voice in this debate. We support and encourage them in that role.
William Caron is president of MaineHealth, a hospital and health care system serving southern, central, western and coastal Maine as well as Carroll County, New Hampshire. Michelle Hood is president of Eastern Maine Healthcare System, an integrated health delivery system serving Maine from Portland to Presque Isle and Blue Hill to Greenville.