U.S. Sens. Susan Collins and Angus King voted courageously in the most recent health care debate. The Affordable Care Act replacement proposals before Congress would have been devastating to rural Maine and especially to our rural hospitals.

Collins in particular stood tall. She faced enormous pressure from a party committed to repealing and replacing the law known as Obamacare. But Collins and King both understood that, while the Affordable Care Act is flawed, the ideas being discussed to fix it might well have had devastating effects, not only on the millions of people who would have lost coverage, but on the nation’s rural health care providers as well.

We are volunteer leaders within Maine’s largest health system, one that includes local health care organizations struggling to survive in the current climate. Some of those struggles are related to the way medicine is changing as new technologies allow more procedures to be done on an outpatient basis while more complex procedures have moved to larger, more urban hospitals.

But much of the stress being placed on organizations like Franklin Community Health Network (parent of Franklin Memorial Hospital) is being driven by laws and policies that create an impossible financial scenario for rural health care providers. The combination of providing care to the uninsured, and Medicaid (known as MaineCare here) and Medicare reimbursements that not only don’t cover the full cost of caring for patients covered under those programs but also have actually declined since the ACA was enacted, has resulted in a serious threat to rural health networks and the health care providers they employ.

That’s because in our rural communities, we have fewer patients with commercial insurance and larger proportions of patients who lack insurance entirely, as well as a higher share of elderly people using Medicare and more low-income people on Medicaid. This has put rural providers of health care on the edge.

The numbers are dramatic.


For instance, last year, 20 of Maine’s 36 hospitals lost money, and those losses were concentrated among rural providers. Indeed, taken together, Maine’s hospitals had a combined operating margin of $29.4 million in fiscal year 2016, but if you take the two largest, Maine Medical Center and Eastern Maine Medical Center, out of that mix, the remaining Maine hospitals lost $50.7 million.

Franklin Memorial Hospital offers a good case in point. The organization has struggled financially in recent years, and last year lost nearly $5 million. Care provided to patients who qualified for free care or could not afford to pay their medical bills cost the hospital more than $3 million alone.

Had plans to repeal the Affordable Care Act moved forward without a thoughtful replacement plan in place, it would have been devastating. Franklin Memorial gets about 4.2 percent of its revenue from patients who have insurance through the Exchange set up under existing law, and the Congressional Budget Office predicted that most of those people would lose coverage under the plans being discussed. Bills floated in the Senate also would have dramatically cut Medicaid. In 2016, those patients accounted for $8.6 million, or nearly 12 percent, of Franklin Memorial’s revenue.

The result surely would have been the devastation of our rural health care infrastructure. Hospitals would have closed. Rural primary care practices would have been shuttered.

In this way, Sens. Collins and King weren’t just protecting access to health insurance for our most vulnerable citizens. People of all income levels in Maine would have lost access to care simply because there wouldn’t be a provider available to treat them. People in northern Franklin County should not have to drive to Lewiston or Portland to access quality care.

This is not to say the current system is ideal or even acceptable. The Affordable Care Act has fundamental flaws that need fixing. For instance, it doesn’t do enough to draw younger, healthier people into the individual insurance market, and that is destabilizing that market and making coverage too expensive.

But King and Collins understand that a solution that devastates our rural health care networks is no solution at all. Maine people can be proud of how our two U.S. senators put the interests of their constituents first, and we should support them as they seek a sensible, bipartisan approach to improving our nation’s health care system, one that must include mechanisms to ensure access to care for our rural citizens.

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