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Richard A. Evans lives in Dover-Foxcroft. Linda Sanborn lives in Gorham. Both are doctors.
We all need relief from high health care costs.
As medical professionals, we care deeply about the health of patients and the strength of Maine’s health care system. We know our hospitals are essential. In a rural state like ours, keeping hospitals open, staffed and functioning is critical to preserving access to care. We all have a stake in that.
But we also see the toll that high health care costs are taking on Maine people. More than one in three Mainers say they have struggled to afford basic needs like food, heat or housing because of medical bills. The affordability crisis is real, and consumers are the ones left holding the bag.
In the past two years, more than four in 10 Mainers have taken on medical debt. Almost one in three families with medical debt owe $5,000 or more. Most report that hospital services, such as surgeries, emergency room visits, labs and diagnostic care, contributed to their debt.
Polling shows seven out of 10 Mainers have delayed or skipped care because of costs. When people cannot afford to use their health insurance, affordability barriers become access barriers.
These are not just numbers. They represent real families making painful tradeoffs: whether to pay for heating or a hospital bill, whether to buy groceries or refill a prescription, whether to seek care now or hope a health problem does not worsen. Mainers should be able to see a doctor and get the care they need without risking financial ruin.
The problem extends far beyond medical bills that arrive after care is delivered. Health insurance premiums are also climbing at an unsustainable pace. This year, Maine’s individual market premiums increased by an average of 23.9 percent, and small-group premiums increased by 17.5 percent.
Think about what this means for an older couple in rural Maine. A 64-year-old couple living in Aroostook County with income just over the limit to qualify for federal subsidies could face premiums that cost half of their income for a silver plan through CoverME.gov — and that is before deductibles and other out-of-pocket costs. That is not a workable system. That is evidence that the system is seriously broken.
Hospital prices are not the only reason health care is unaffordable. Prescription drugs and other challenges also play a role. But hospital prices are one of the largest drivers of premium increases, and we can no longer avoid that conversation.
Maine hospital prices are higher than average by several measures. One analysis found average inpatient prices in Maine were about 20% above the national average. One hospital in Maine had prices in the top 88% of hospitals nationally.
Without guardrails for how much hospitals can charge, they will continue the pattern of increasing costs to cover shortfalls. These costs are out of balance with what families and businesses can bear.
Saying that is not an attack on hospitals. It is recognizing that the burden of rising costs is increasingly falling on patients. Consumers are the ones left with higher premiums, higher deductibles, growing medical debt and delayed care.
The current trajectory is unsustainable — for patients, employers and the state as a whole. We need to start bending the cost curve in a thoughtful way that protects access while addressing prices that are out of step with what Maine families and businesses can afford. Evidence from other states suggests it is possible to moderate hospital prices without compromising care. Investing more in comprehensive team-based primary care concurrently would also help to slow the rate of increasing hospital prices.
Maine people need relief from high health care costs. They deserve a system that preserves local hospitals, strengthens access to care and makes health care more affordable. Polling shows a vast majority of Mainers support limiting the amount paid for hospital services.
We do not have to choose between preserving our hospitals and protecting patients from crushing costs. We can, and must, do both.