Insurance, not ‘access’

To the Editor:

We medical providers at Mount Desert Island Hospital are very concerned that the Republican replacement to the Affordable Care Act (ACA) will prevent many of our patients who have had the benefit of health insurance through the ACA from continuing to have insurance.

For the last six years, it has been a pleasure to see and treat more of our neighbors for routine and preventative care. Previously, we saw them only when they had acute problems either because they had no insurance or they had a health plan with such high deductibles they could not see us in a timely fashion to prevent health problems from becoming worse.

The nonpartisan Congressional Budget Office has concluded that under the current Republican plan, 14 million Americans would lose insurance in 2018, rising to 24 million over the decade. In the first year alone, premiums for those still covered would average 15 to 20 percent higher than they would have been under the ACA.

By in large, older Americans would pay “substantially” more while younger insured would pay less. At the same time, the plan would slash millions of dollars in taxes paid by the very wealthy and insurance companies.

Northern and Eastern Maine, home to some of the poorest and oldest populations in the country, will be particularly hard hit. For example, according to data from the Kaiser Family Foundation, a 60-year-old Hancock County resident who makes $30,000 and who is now covered under the ACA receives a $13,210 subsidy for insurance. Under the Republican bill, this person would receive $4,000 – a 70 percent cut.

The supporters of the bill tout insurance “access.” Our 60-year-old Hancock County neighbor and millions of others will have “access” to insurance in the same way they have “access” to buying private jets, which is to say, not at all.

MDI Hospital helped more than 800 of our neighbors sign up for insurance through the health insurance marketplace of the ACA. We do not know how many will be able to afford comprehensive insurance under the proposed law, but it is unjustified to believe it will be a lot of them.

Don’t rest easy if you think this won’t affect you. It isn’t just other people who will lose. The whole system will be put under enormous strain.

Right now, the MDI Hospital annually labors to provide about $5 million in unpaid care, in large part due to the state’s refusal to expand Medicaid under the ACA to help the working poor get insurance and by its additional cuts to thousands of others from state Medicaid coverage. That $5 million bill doesn’t just disappear. Every year, it has to be paid somehow.

If the Republican bill becomes law, for every additional person without insurance to whom we provide care they can’t reasonably pay for, the higher that unpaid debt will climb.

Assuming for a moment that the hospital can continue to bear this burden in an environment in which half the hospitals in the state of Maine are already operating in the red, higher shifted costs will result in higher bills and premiums and/or the elimination or curtailment of services to everyone. For example, in the face of overwhelming need, Medicaid cuts caused us to close an outpatient opiate treatment program a couple of years ago. The hospital is still struggling to find a way to provide a replacement program.

This country is again at a crossroad we should have long ago gotten beyond. Do we agree that health care is a necessity and human right for all? Will we commit to a workable way to do that? Or, as the authors of the Republican plan advocate, do we rely on the so-called free market, where, by inescapable definition, there are winners and losers?

If you truly support that and you don’t want to cause institutions like the hospital to collapse for everyone, you must be willing to accept that some of your neighbors may not be able to access necessary health care. We must each take personal responsibility for the unavoidable consequences of choosing to create health care haves and have-nots. You can’t keep expecting our nonprofit health care institutions to somehow make up the difference.

In a healthcare “free market” losers suffer more and die faster and harder than winners. As your health care providers, we find that utterly unacceptable.

If you share our concerns, please make your voice heard now.

Sen. Susan Collins, Bangor: 945-0417, Washington: (202) 224-2523

Sen. Angus King, Bangor: 945-8000, Washington: (202) 224-5344

Rep. Bruce Poliquin, Bangor: 942-0583, Washington: (202) 225-6306

Julian Kuffler, MD MPH

Brenda Beckett, PA-C

Brian Caine, MD

Linda Crowell, FNP-C

Stuart Davidson, MD

Nathan Donaldson, DO

Mary Dudzik, MD

Ann Dundon, PA-C

Edward Gilmore, MD

Mark Kandutsch, MD

Stephen Koscherak, Ph. D

J.R. Krevans Jr. MD

Meagan Lamothe, FNP-C

Vanessa Little, DO

Linda Maxwell, PA-C

Gordon Murphy, PA-C

Rachael Sharp, CRNA

Diehl Snyder, MD

Jane Tawney, PA-C

John Urbanek, DO

Bar Harbor

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