Hospital officials in Maine are raising concerns about how President Trump's massive budget and domestic policy bill passed by Congress will affect facilities across Maine, particularly those in rural areas.
The so-called "One Big Beautiful Bill" partially pays for extending the 2017 tax cuts and President Trump's border security initiatives by cutting nearly $1 trillion dollars from Medicaid. The bill, which the House sent to Trump's desk Thursday afternoon, also makes changes to enrollment and subsidy policies under the Affordable Care Act.
Various studies project that anywhere from 40,000 to 60,000 Maine residents could lose health insurance as a result of the changes. And that would put an additional financial strain on hospitals — especially rural hospitals — that cover uninsured people who come to emergency rooms for care.
"There are hospitals today that are at risk today because of a number of difficult financial challenges," said Jeff Austin, vice president of government affairs at the Maine Hospital Association. "Anything that adds to it — including congressional action, a recession, state action — all of it is a concern. We've seen one (hospital) close and we have a few others that are in pretty precarious situations without any policy changes. So, yeah, we have concerns."
Northern Light Inland Hospital in Waterville closed earlier this year because of financial challenges after more than 80 years of operation. Several analyses released by health care advocacy groups and Democratic lawmakers during the debate over Trump's bill suggested that between two and five of Maine's rural hospitals could be at risk of closure because of the loss of Medicaid funding and other changes in the bill.
All four members of Maine's congressional delegation — Republican Sen. Susan Collins, independent Sen. Angus King and Democratic Reps. Chellie Pingree and Jared Golden — voted against the bill. Democratic Gov. Janet Mills has also warned that the bill could blow a hole in the state budget because it shifts more of the costs to states for other social welfare programs, including the Supplemental Nutrition Assistance Program formerly known as food stamps.
Austin as well as other leaders of Maine's hospital network publicly thanked the delegation members for their work on the bill.
“While we cannot quantify the full impact until the final legislation is analyzed, the $1 trillion in cuts to health care will have significant repercussions to vulnerable Maine families and the hospitals that support them," MaineHealth Chief Government Affairs Officer Katie Fullam Harris said in a statement. "The impact of this bill will add significant stress to Maine’s hospitals, which are already struggling to maintain access to care for their communities.”
MaineHealth operates seven rural hospitals in Maine as well as Maine Medical Center in Portland.
On Tuesday, Northern Light Health referenced the coming changes to Medicaid in a press release that forecast additional workforce and program changes were needed to put the network onto a "path to financial sustainability. The statement from Maine's second-largest hospital and health care provider also cited rising supply and costs, low reimbursement rates and high denial rates from insurance providers.
"No hospital will be closed as a part of this work, however some services offered at some locations could change," Northern Light said in the release.
Collins, who was one of three Republicans to vote against the bill in the Senate, said in an interview with Maine Public on Wednesday that she supported many of the tax provisions of President Trump's budget and policy bill. The bill extends the 2017 tax cuts that, without congressional action, would have expired later this year, resulting in tax increases for most Americans. The bill also enhances tax benefits for working families and older individuals while allowing workers to deduct income from tips and overtime from their taxes.
But said her concerns about deep cuts to Medicaid prompted her to vote against the measure. The Republican called Medicaid a health care safety net for nearly one-third of Maine's population, including seniors, disabled children and low-income families.
"And I was also concerned about the impact on our rural hospitals and nursing homes, in particular," Collins said. "So that health care infrastructure in our state is going to be harmed by this bill."
Collins helped negotiate a provision in the final version of the bill that sets aside $50 billion to offset some of the losses incurred by rural hospitals nationwide because of the Medicaid changes.
