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Steve Bien is a privately practicing family physician in Farmington. He has been in practice there since 1982.
The health and healthcare of Second Congressional District voters are on the line in this election so we should choose carefully. Due to federal health funding cuts, a financial tsunami is poised to hit patients, providers, and our hospitals.
Maine’s health care system is already stressed. Staff retention is problematic at all levels, several major practices have closed recently, and a number of hospitals are on the verge of shuttering. This is the backdrop for the coming loss of federal Medicaid funds to Maine. In my 40 years in medicine, I have never seen resources so thinly stretched.
No issue will be more important to our two congressional candidates, Matt Dunlap and Paul LePage. Their responses will impact every Mainer.
The tsunami is the catastrophic reduction in healthcare funding scheduled to hit our state next year because of President Donald Trump’s One Big Beautiful Bill. To fund tax cuts for the wealthy, the Republican Congress took $1 trillion from Medicaid. Our state’s hit is predicted to be $345 million per year.
Medicaid funds health care for about 30% of Maine residents and represents approximately 18% of state hospital incomes. In some 2nd District communities MaineCare provides as much as 60% of facilities’ budgets.
How does that gap get closed when many hospitals are operating on less than a 5% profit margin. The answer is it doesn’t. Katie Fullam Harris, chief government affairs officer at MaineHealth, recently said: “Maine’s healthcare infrastructure is teetering on the edge of real challenge right now … There’s no room to absorb additional costs.”
Already we have seen primary care offices close in Houlton, Presque Isle, Waterville, Fairfield, Oakland, Castine and Manchester. Downeast Ob-Gyn in Bangor shut down because they could not retain and recruit physicians. Twelve Maine birthing centers have closed in the last decade. Routine care for pregnant women in those areas now requires an average of 45 minutes of travel.
There are 24 rural hospitals in Maine and 10 are at risk of closing. Four are at risk of closing in the next three years (Presque Isle, Ellsworth, Caribou, and Calais). MaineCare covers nearly 40% of all births in Maine, so the access to care for women and infants will only get much worse.
My patients commonly wait six months or longer for referrals to rheumatology, dermatology, cardiology and gastroenterology, if those referrals are accepted at all.
How will our two congressional candidates face this crisis?
Paul LePage was no fan of MaineCare during his tenure as governor. He dismissed it as “welfare” and resisted any effort to expand it. He now says that its expansion is the source of our state’s health care finance woes, not part of any solution. In response to the hospital funding crisis he faced during his second term as governor, LePage said “we definitely have too many hospitals.”
None of our state’s hospital administrators seem to agree with him and all are alarmed by the prospect of the coming cuts, which will create a financial hole they cannot fill.
Candidate Matt Dunlap pledges to do what he can to restore federal funding so that we can preserve what we have. Beyond that, Medicare for all, meaning an expansion of publicly funded health care, is the centerpiece of his campaign.
I believe Medicare for all is the ideal solution to the MaineCare problem we are facing. Medicare, since it serves everybody over 65, is widely respected and supported by politicians across the spectrum. The public correctly sees Medicare as an essential benefit to ensure appropriate care for the elderly. In contrast, cuts to Medicaid, which undermine care for the less politically powerful low-income population, came right out of a cynical political playbook. I believe Medicare for all would be a step toward better care for all Mainers regardless of age or income.
The axe falling on MaineCare funding is timed to fall after the midterm elections. We need to be aware of the impending cuts and keep them uppermost in our minds when we vote in this election.