Editor’s note: Tufts medical students Rajesh Reddy and James Lee also contributed to this op-ed.

When each of us chose to pursue medicine, we did so for various reasons. But as medical students training in Maine, we have united around a common purpose: to serve the people of Maine. We have grown sensitive to the health needs of our future patients as we witness the challenges of the Mainers who come into our clinics. After learning of the potential changes outlined in the American Health Care Act, we are deeply concerned about the impact that this bill would have on the people of Maine.

As students at Maine-affiliated medical schools, we are concerned by record drug overdose deaths in our hometowns and the growth in premium rates. We agree with the authors of last Thursday’s editorial: These effects burden all Mainers, but the underserved and uninsured suffer most. When we work in clinics across the state, we see what happens when our poor cannot afford care: patients with diabetes losing their sight, elderly patients missing medications, women diagnosed with breast cancer too late.

We are anxious about the impact that the American Health Care Act would have on our patients who need care the most, especially our elderly and poor. For these groups, the proposed tax credits would provide weaker support than the Affordable Care Act subsidies now offer. Many of those Mainers who manage to afford insurance will find themselves paying more for less care. Patients who depend on Planned Parenthood for their health care would be left without access to care.

We are especially worried for our patients with addiction, who, more than most, are threatened by loss of care. Even now, patients who seek treatment for drug addiction have a difficult time getting it.

At this critical point, Mainers need a law that will maintain or increase access to affordable, quality coverage while containing premium costs. We believe that the AHCA would not only fail both goals, but also would withdraw protections for Maine’s more vulnerable citizens. We want to highlight several of many aspects of the proposal that will threaten our patients across Maine.


Maine has the oldest population in the nation. The ACA prevents insurers from charging older patients more than three times that of young adults. Under the AHCA, they can be charged five times as much; while a young adult might pay $200 a month, an older Mainer could pay $1,000 a month for the same coverage.

The AHCA proposes significant changes to the Medicaid program, which serves Maine’s low-income and disabled populations. If those changes result in less federal support for Maine’s Medicaid program, Maine’s ability to respond to increasing health care demand from its most vulnerable citizens would be severely impaired. The current opioid epidemic also has a disproportionate impact on Medicaid beneficiaries. Any reduction in coverage, benefits or resources for the Medicaid program would leave Mainers on their own and hinder our ability to fight the ongoing epidemic.

Maine would suffer from a nationwide increase in premiums, estimated to increase by $2,409 by 2020 for an average enrollee in the individual market. Enrollees would also lose the ACA’s subsidy system. Under the AHCA, a 60-year-old Cumberland County resident could see subsidies decrease by as much as $5,290, leaving the rest to be paid out of pocket. Mainers between 55 and 64 and those with low incomes would be hit harder by the rigid tax credit system.

The AHCA threatens the sustainability of rural Maine hospitals. Maine’s rural hospitals are struggling to maintain access to care today, and they will be seriously challenged to care for a growing uninsured population. Rural hospitals are at greater risk, as their patients disproportionately rely on ACA exchange subsidies and government plans for their coverage. If further challenged by increases in bad debt and charity care, rural hospitals would face very difficult decisions about the programs and services they provide and the staff they employ.

As Maine’s future physicians, we are committed to providing health care for anyone who needs it. We believe that the American Health Care Act would hurt our most vulnerable patients and undermine accessible, affordable and high-quality care for all Mainers. Maine has an opportunity to show the nation that the health of its citizens supersedes politics. Dirigo means “I lead.” Let’s lead by supporting more and better access to health care, not less.

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