According to the 2020 census, nearly half of the Mainers who have health insurance receive it through their employer. Because Maine is among the most expensive states in the country in which to receive health care, business owners who provide health insurance are faced with maintaining coverage at higher costs, cutting back coverage – which leaves employees with higher deductibles and co-pays—or laying off employees.

The trend of steadily rising health care costs needs to be reversed. A survey conducted late last year by the non-profit Altarum found:

• 63% of Americans experienced one or more health care affordability burdens in the past year;

• 80% are worried about affording healthcare in the future;

• 59% are worried about affording treatment for COVID-19 if they need it.

And across party lines, respondents express strong support for government-led solutions.

The complaints are the same throughout the country. Insurance companies nickel-and-diming patients and hospitals for necessary care that often borders punishment for the “crime” of being ill or injured. Meanwhile, hospitals charging ridiculous prices for mundane items is as legendary as the Pentagon’s $450 hammers.

The ever-rising cost of care is killing us. As costs rise, insurance premiums rise, and more people get left behind. Employers – especially small business owners – who try to do right by providing health insurance are increasingly unable to. The root problems must be solved. Unless policies are enacted to fix our health care system by reducing costs nothing will change. If we want insurance companies to stop dictating what care we can and cannot receive, then we need the cost of that care to come down.

We need physicians and hospitals to be reimbursed promptly by federal and state programs and by insurance companies. We also need enforced transparency in billing as well as accountability on what hospital consolidation costs patients. As individual hospitals morph into mega-systems, patients lose the opportunity to shop around.

Thirty-three of Maine’s 36 hospitals are non-profit and that’s a good thing. But MaineHealth operates eight of them, as well as hundreds more physician practices, clinics, labs, and other health care sites.  Northern Light Health includes 10 hospitals, 37 primary care locations, and eight nursing homes. Central Maine Healthcare operates four hospitals as well as Maine Urgent Care. MaineGeneral Health also maintains multiple health care offices in addition to its two hospital campuses in Augusta and Waterville.

That’s a lot of consolidation that doesn’t invite a lot of competition.

We need current federal and state regulations, which are meant to provide oversight, to be enforced consistently. A recently released study published by JAMA Internal Medicine found that median price markups across 61 National Cancer Institute–designated hospitals ranged from approximately 120% to 630% of estimated hospital acquisition costs. The study also found that most of these hospitals “did not publicly disclose payer-specific prices for cancer therapies as required by federal regulation.” The study concluded, “to reduce the financial burden of cancer treatment for patients, institution of public policies to discourage or prevent excessive hospital price markups on parenteral chemotherapeutics might be beneficial.”

In 2021, The Commonwealth Fund analyzed the performance of health care systems of 11 high-income countries including the United States. We ranked last overall, despite spending far more of our gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes.

Maine cannot grow its economy without addressing its rising health care costs. Those high costs are driving down the value of everyone’s paychecks by driving up insurance premiums as well as deductibles and co-pays. On a larger scale, it causes businesses to rethink their investments in Maine.

We need more predictability and transparency in pricing, and we need more competition in the delivery of care. We need the legislature and key decision makers to take this seriously and work to bring down the cost of health care in Maine.

— Special to the Press Herald