The news was from Bridgton last week, but it could have come out of any of the Maine towns that are home to rural hospitals.
Employees of Bridgton Hospital have issued no-confidence votes for their corporate parent, Central Maine HealthCare, and its CEO, Jeff Brickman. Town officials say they have been informed that there may soon be job losses. They are also worried about a loss of services, including the elimination of the obstetrics department, meaning that expectant mothers would have to drive a long distance when it’s time for them to give birth.
A decision like that would have devastating consequences for a town like Bridgton. The hospital is their largest local employer and the loss of an obstetrics unit would speed up troubling economic trends that affect all rural communities — such as the outmigration of young families, the aging of the workforce and stagnant economic growth.
Health care economics are complicated, and there is no easy fix for problems that are decades in the making. But there is something the state should do immediately to help communities like Bridgton: Expand Medicaid as soon as possible.
Medicaid is a major source of income for health care providers in low-income areas. In the past, hospitals like the one in Bridgton would receive extra funds from the federal government to help them serve these communities, but those funds were cut back when the Affordable Care Act was passed.
Since the money was going to be redirected to cover more people by raising the income eligiblity level for Medicaid, it looked like a good deal for the hospitals since it would create more paying customers for them. But then the U.S. Supreme Court made Medicaid expansion optional, and Maine became one of the states that refused to participate.
With no one to pay the bills, hospitals are forced to look at cutting costs, and obstetrics, which is a money loser, is always on the list. The hospital in Calais closed its maternity unit last year, joining a national trend even though 90 percent of the cost would come from the federal government.
According to Becker’s Health Care News, all rural hospitals are feeling the squeeze, but the pressure is most accute in the states that have refused to expand Medicaid. “In expansion states, we see exactly what we would expect to happen after Medicaid became available to more people,” said Sayeh Nikpay, M.D., lead author of the University of Michigan study. “Even in these early months, the shift from uninsured to Medicaid contrasts sharply with the steady demand for uninsured in non-expansion states. This has implications for the financial status of hospitals.”
Medicaid expansion is not a magic wand that would cure all of the problems faced by small hospitals. Our whole health care financing system rewards the kinds of services provided in big cities by regional medical centers, while shortchanging treatment for chronic conditions. As expensive new technology draws even more of the most lucrative procedures to big institutions, small rural hospitals are left delivering treatment that does not generate high revenues. If Maine expanded Medicaid, obstetrics would still be a money loser, but hospitals would be providing less free care and have more revenue coming in to cover costs.
Bipartisan majorities in both houses of the Legislature have passed Medicaid expansion five times, provoking vetoes from Gov. Paul LePage each time. Last year, the voters passed a referendum to expand Medicaid, which received almost 60 percent of the vote, but the governor created new obstacles by vetoing a bill that would appropriate funds to cover the administrative costs.
A judge ordered LePage to move forward, but he appealed the decision. Now everyone is waiting to see if the state supreme court will let him continue to stand in the way.
LePage says that Maine can’t afford to expand Medicaid, but what’s going on in Bridgton should show why we can’t afford not to.
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