Senator Susan Collins a very senior senator who could have opposed cuts to Medicaid but now Maine people are harmed by her terrible vote

 https://themainemonitor.org/hospitals-brace-medicaid-cuts/

Maine hospitals brace for Medicaid cuts

By Rose Lundy published in Maine Monitor

Thousands of people are expected to lose Medicaid, but no one knows exactly who will lose coverage or which parts of Maine will be hit hardest. Senator Susan Collins supported the law to cut Medicaid while giving tax cuts to herself and to her multimillionaire friends. 

Maine health care providers are grappling with how to prepare for more patients without insurance.

As premiums rose and tax credits expired, the number of people enrolled in the state’s health insurance marketplace dropped by thousands from 2025, to 2026. Now, thousands more Mainers are expected to lose their Medicaid coverage when a new federal law takes effect.

But no one knows exactly who will lose their Medicaid coverage or where they live, making it difficult for providers to predict what could happen when the new eligibility rules start rolling out in three months.

“It’s really a perfect storm,” said Kate Ende, policy director for Consumers for Affordable Health Care, a nonprofit that helps people navigate access to health care. “Whether you’re losing Medicaid — MaineCare — or you’re losing coverage because you simply can’t afford it anymore because premiums have just skyrocketed, in both situations you’re losing access, and you’re less likely to seek preventive and routine care.”

With rates for private health insurance estimated to rise again, it is likely that more Mainers will voluntarily drop their insurance. Maine insurers have proposed an average increase of about 15 percent for individual plan premiums, which the Maine Bureau of Insurance will review and finalize in mid-August. Last year, rates increased an average of 24 percent for the individual market.

Insurers said higher rates are necessary due to the increasing cost of medical care, higher use of medical services, higher prescription costs, the expiration of the enhanced premium tax credit, and worsening health of insured people in the individual and small-group market, said Tim Schott, acting superintendent of the Maine Bureau of Insurance. The enhanced premium tax credit lowered monthly health insurance payments for eligible individuals and families, and was not extended by Congress in 2025.

More people tend to go without, or switch to catastrophic plans, when prices rise. As of February, there was a nearly 10 percent decline in enrollments on the state-based marketplace for private insurance compared with last year, according to the state. Plan cancellations were especially high among younger people and Mainers who previously received a health insurance tax credit.

On top of this turmoil, changes to Medicaid are starting to take effect this fall. Last summer, Republican lawmakers- including Senator Susan Collins, in Congress passed the One Big Beautiful Bill, which will cut Medicaid spending by an estimated $911 billion over the next decade. The law includes new work requirements for some Medicaid recipients and changes to eligibility for some immigrants.

Beginning on October 1, more than 600 immigrants, including refugees and asylum seekers who have not yet received a green card, likely will no longer be eligible for full benefits under MaineCare, the state’s version of Medicaid, according to the state. Children and pregnant women will be exempt.

On January 1, new work requirements will take effect for people who qualified for Medicaid after the state opted to expand coverage to them in 2019. There are an estimated 86,000 members in the state’s expansion group who will now have to show they are working, volunteering or attending school for 80 hours a month to keep their coverage.

The state has previously estimated that 31,000 of those people would lose their coverage because they no longer qualify or because the additional paperwork will be too much of a barrier.

Ende, with Consumers for Affordable Health Care, said people who are still eligible may find the new requirements confusing or more difficult because they will have to report every six months instead of once a year 😡😟😞😢and will have to do more to prove they are working or are too sick to work.

“People have busy lives, and they’re already juggling a lot,” Ende said. “People are moving, and they may not be at the same physical address they were. They may have unstable housing. There’s a lot of reasons why these overly burdensome paperwork requirements can cause somebody who is eligible to lose coverage.”

Providers are struggling to anticipate exactly how many in their service area could lose coverage, but they are budgeting for rising costs from uninsured patients.

MaineGeneral Health, the health system that serves central Maine and has Maine General Medical Center as its flagship hospital in Augusta, estimated that 3,000 people in its service area could lose coverage. The health system is budgeting for an increase in charity care in the current fiscal year, which began July 1, according to Terry Brann, Maine General’s chief financial officer. Some of that predicted increase is due to a state law passed last year that expands who is eligible for charity care.

Charity care, which hospitals are required to provide when patients come to the emergency department but can’t pay their bills, was already high. Maine hospitals provided nearly 💲60 million in charity care in 2023, according to a previous Maine Monitor analysis of data from the Maine Health Data Organization.

Brann said rising rates of uninsured people in Maine will have long-term consequences for MaineGeneral’s financial stability.

“We have seen impacts to access across the state for OB/GYN services, primary and specialty care services. These changes will continue to impact us and others across the state — making it even harder for patients to access timely care,” Brann said. “We’ve had to make difficult decisions about what programs and services we can provide long-term.”

But predicting which parts of Maine will see the most people lose their Medicaid coverage is difficult. Brann said Maine General has no breakdown of where the state could be hit hardest.

On one hand, there are more people on Medicaid in northern Maine. About 34 percent of Mainers in the 2nd Congressional District are on Medicaid, compared with about 23 percent in the 1st Congressional District, according to KFF, a health policy organization.

However the new work requirements are only required for select people with Medicaid — those in the Medicaid expansion population — and it’s not clear how many of them live in the 2nd District.

The new law also carves out exemptions to the new work requirements for certain people, such as those who are caregivers, or have substance use disorders or chronic conditions. These exemptions make it challenging to predict exactly which parts of the state will see the most people lose coverage, said Trevor Putnoky, president and CEO of the Healthcare Purchaser Alliance of Maine.

“It’s almost impossible to tell,” Putnoky said. “You would have to have really detailed demographic workforce data to be able to model out how this is going to impact people.”

John Porter, a MaineHealth spokesperson, said it is “not knowable” how the new work requirements and additional paperwork will impact MaineCare coverage.

“One factor is what steps, if any, will the state take to ease the administrative burden on the eligible Medicaid population,” he said. “Another factor is what the final rules will be with regard to exemptions from the work requirements.”

The Medicaid cuts will come after MaineHealth lost $48.7 million as of June 30, against a budget that called for a financial gain of $64 million in the same period, he said. This excludes one-time COVID relief payments.

There are other reasons why northern Maine is likely to be hit harder by health insurance upheaval as a whole, however, Putnoky said. There are more small-group employers in northern Maine who have a harder time weathering rising health insurance costs. These employers may have to end coverage or instead offer employees a stipend to buy their own plans on the marketplace where premiums are much higher. The 2nd District also has more seasonal workers who could find it difficult to complete additional paperwork to meet work requirements.

What’s more, northern Maine has an older population with more chronic diseases, said Lisa Harvey-McPherson, vice president of government affairs for Northern Light Health, based in Brewer. People who don’t have coverage often delay their care and then go to the emergency department when their needs are more complex and more acute. As a result, the cost for the patient is higher, she said. In comparison, southern Maine has more commercial payers, so it’s a more stable market.

Northern Light Health has previously estimated it will lose about $27 million in the first year of Medicaid cuts. The losses will come at a precarious time for the health system, which recorded about 💲26 million in bad debt in 2024, and $12.1 million in charity care.
There are health disparities between northern and southern Maine. The 1st District met or performed better than the national average on all but one of 42 health outcomes measured by Congressional District Health dashboard. The 2nd District was worse than the national average on six metrics: firearm suicides, frequent mental distress, frequent physical distress, independent living difficulty, opioid overdose deaths and smoking.

A recent national report from a coalition of nine civil rights and health care advocacy groups estimated that 60 percent of people who lose coverage will be from communities of color.

Disparities grow when sicker people have less access to health care, Putnoky said. Ending up in the hospital is expensive and can lead to medical debt, bankruptcy or charity care covered by the hospital, which must absorb the expenses by cutting or raising costs elsewhere.

“They don’t have insurance, and they’re going to get saddled with enormous amounts of medical debt,” Putnoky said. “Somebody’s going to pay for it, right? Either they’re on the hook for it, and it’s going to put them in a really difficult position, or the hospital is going to be on the hook for it, and they’ll see their charity care percentage tick up.”

Beginning on October 1, more than 600 immigrants, including refugees and asylum seekers who have not yet received a green card, likely will no longer be eligible for full benefits under MaineCare, the state’s version of Medicaid, according to the state. Children and pregnant people will be exempt.

On Jan. 1, new work requirements will take effect for people who qualified for Medicaid after the state opted to expand coverage to them in 2019. There are an estimated 86,000 members in the state’s expansion group who will now have to show they are working, volunteering or attending school for 80 hours a month to keep their coverage.

The state has previously estimated that 31,000 of those people would lose their coverage because they no longer qualify or because the additional paperwork will be too much of a barrier.

Ende, with Consumers for Affordable Health Care, said people who are still eligible may find the new requirements confusing or more difficult because they will have to report every six months instead of once a year and will have to do more to prove they are working or are too sick to work.

“People have busy lives, and they’re already juggling a lot,” Ende said. “People are moving, and they may not be at the same physical address they were. They may have unstable housing. There’s a lot of reasons why these overly burdensome paperwork requirements can cause somebody who is eligible to lose coverage.”

Providers are struggling to anticipate exactly how many in their service area could lose coverage, but they are budgeting for rising costs from uninsured patients.

MaineGeneral Health, the health system that serves central Maine and has MaineGeneral Medical Center as its flagship hospital in Augusta, estimated that 3,000 people in its service area could lose coverage. The health system is budgeting for an increase in charity care in the current fiscal year, which began July 1, according to Terry Brann, MaineGeneral’s chief financial officer. Some of that predicted increase is due to a state law passed last year that expands who is eligible for charity care.

Charity care, which hospitals are required to provide when patients come to the emergency department but can’t pay their bills, was already high. Maine hospitals provided nearly $60 million in charity care in 2023, according to a previous Maine Monitor analysis of data from the Maine Health Data Organization (MHDO).




Brann said rising rates of uninsured people in Maine will have long-term consequences for MaineGeneral’s financial stability.

“We have seen impacts to access across the state for OB/GYN services, primary and specialty care services. These changes will continue to impact us and others across the state — making it even harder for patients to access timely care,” Brann said. “We’ve had to make difficult decisions about what programs and services we can provide long-term.”

But predicting which parts of Maine will see the most people lose their Medicaid coverage is difficult. Brann said MaineGeneral has no breakdown of where the state could be hit hardest.

On one hand, there are more people on Medicaid in northern Maine. About 34 percent of Mainers in the 2nd Congressional District are on Medicaid, compared with about 23 percent in the 1st Congressional District, according to KFF, a health policy organization.

However the new work requirements are only required for select people with Medicaid — those in the Medicaid expansion population — and it’s not clear how many of them live in the 2nd District.

The new law also carves out exemptions to the new work requirements for certain people, such as those who are caregivers, or have substance use disorders or chronic conditions. These exemptions make it challenging to predict exactly which parts of the state will see the most people lose coverage, said Trevor Putnoky, president and CEO of the Healthcare Purchaser Alliance of Maine.

“It’s almost impossible to tell,” Putnoky said. “You would have to have really detailed demographic workforce data to be able to model out how this is going to impact people.”

John Porter, a MaineHealth spokesperson, said it is “not knowable” how the new work requirements and additional paperwork will impact MaineCare coverage.

“One factor is what steps, if any, will the state take to ease the administrative burden on the eligible Medicaid population,” he said. “Another factor is what the final rules will be with regard to exemptions from the work requirements.”

The Medicaid cuts will come after MaineHealth lost $48.7 million as of June 30, against a budget that called for a financial gain of $64 million in the same period, he said. This excludes one-time COVID relief payments.

There are other reasons why northern Maine is likely to be hit harder by health insurance upheaval as a whole, however, Putnoky said. There are more small-group employers in northern Maine who have a harder time weathering rising health insurance costs. These employers may have to end coverage or instead offer employees a stipend to buy their own plans on the marketplace where premiums are much higher. The 2nd District also has more seasonal workers who could find it difficult to complete additional paperwork to meet work requirements.

What’s more, northern Maine has an older population with more chronic diseases, said Lisa Harvey-McPherson, vice president of government affairs for Northern Light Health, based in Brewer. People who don’t have coverage often delay their care and then go to the emergency department when their needs are more complex and more acute. As a result, the cost for the patient is higher, she said. In comparison, southern Maine has more commercial payers, so it’s a more stable market.

Northern Light Health has previously estimated it will lose about $27 million in the first year of Medicaid cuts. The losses will come at a precarious time for the health system, which recorded about 💲26 million in bad debt in 2024, and $12.1 million in charity care.

There are health disparities between northern and southern Maine. The 1st District met or performed better than the national average on all but one of 42 health outcomes measured by Congressional District Health dashboard. The 2nd District was worse than the national average on six metrics: firearm suicides, frequent mental distress, frequent physical distress, independent living difficulty, opioid overdose deaths and smoking.

A recent national report from a coalition of nine civil rights and health care advocacy groups estimated that 60 percent of people who lose coverage will be from communities of color.

Disparities grow when sicker people have less access to health care, Putnoky said. Ending up in the hospital is expensive and can lead to medical debt, bankruptcy or charity care covered by the hospital, which must absorb the expenses by cutting or raising costs elsewhere.

“They don’t have insurance, and they’re going to get saddled with enormous amounts of medical debt,” Putnoky said. “Somebody’s going to pay for it, right? Either they’re on the hook for it, and it’s going to put them in a really difficult position, or the hospital is going to be on the hook for it, and they’ll see their charity care percentage tick up.”

Timely access to mental health care continues to increase risk of suicide

Between 2015, and 2020, the number of practicing licensed psychiatrists in Maine dropped by half to 110, a drop-off due largely to retirements hastened by the pandemic. 

Suicide attempts continue to rise as wait times for accessing help grows longer. An echo report by Rose Lundy, writing for The Maine Monitor.

Money from the Mills administration has poured money into behavioral health services, but one expert says there’s not enough money in the government to fix the problems.

Demand for mental health services that peaked during the pandemic has remained stubbornly high, increasing waitlists and spilling patients into Maine’s hospital emergency rooms.

Prior to COVID-19, Mainers might wait weeks to see a behavioral health specialist. Now waitlists are months long, said Dr. Anthony Ng, ​​medical director for community services at Northern Light Acadia Hospital.

“You could put them on the waitlist but for every moment they wait, weeks and months, their illness could worsen,” Ng said.

Maine was losing psychiatrists in the years leading to the pandemic, and the numbers have continued to drop. In 2019, three counties — Franklin, Piscataquis and Sagadahoc — did not have any psychiatrists, according to a statewide report released last month.

Staff shortages during the pandemic forced outpatient programs to reduce services despite rising rates of isolation, depression and anxiety at a time of economic uncertainty and political discontent, said Ng, who also is a Distinguished Fellow of the American Psychiatric Association.

Maine already had high suicide rates before the pandemic: In 2019, the state suicide rate per 100,000 was 19.4 compared to 13.9 nationally.

COVID-19 made the situation worse, and the need for services has not alleviated despite the easing of pandemic lockdowns that caused widespread isolation, mental health professionals told The Maine Monitor.

Linda Durst, M.D.

Linda Durst, chief medical officer with Maine Behavioral Healthcare, said she has tracked more suicide deaths during the pandemic than in the five years prior. In particular, she’s seen an “acceleration in severe suicide attempts in youth.” Durst also chairs the department of psychiatry at Maine Medical Center.

The numbers have been higher in the past year, perhaps because as the pandemic has dragged on, “people have gotten less hopeful,” Durst said. And delayed care meant that people who seek care had more severe cases.

But there are efforts to address this. Gov. Janet Mills allocated $230 million for behavioral health services this fiscal year, including $15.4 million released in June to help reduce waitlists for community-based services and reduce emergency department use for behavioral health crises. And Maine Medical Center has expanded its psychiatry residency program into rural communities.

Experts say the pandemic is an opportunity to rethink the way they deliver mental health services.

Emergency rooms get much busier

When there aren’t enough treatment providers, people with more severe mental health challenges usually end up in emergency rooms.

Behavioral health visits to emergency rooms in Maine hospitals have remained 25% higher than before the pandemic, according to a survey conducted this week by the Maine Hospital Association. The length of stay in the emergency room has increased 25% — and in some cases as much as 35-40%.

At one point last year, psychiatric patients took up half the emergency beds in Maine’s largest hospital system, the Bangor Daily News reported.

Keeping patients in emergency room beds for extended stays — a practice called boarding — is one of the top problems facing hospitals, said Steven Michaud, president of the Maine Hospital Association. It’s a bad situation for everyone because the patient doesn’t receive the long-term level of care needed, it puts an extra strain on staff and takes away beds from other patients.

Hospitals have seen rising rates of violence from patients toward staff as a result.

“It doesn’t mean that all behavioral health patients are violent. Not at all. But they are disproportionately more so, and to say otherwise is just not facing reality,” Michaud said. “So when we have these patients it is more dangerous for our staff in the emergency room.”

Workforce shortages are part of the problem, but the lack of an adequate number of treatment centers goes back to the national movement in the 1970s, and 1980s to shrink state mental health facilities, Michaud said.

“This is a long-standing problem, which tells you there hasn’t been enough services out in the community for years, if not decades,” Michaud said. “And by the way, this is a national phenomenon. Everybody like me is pulling their hair out about this across the country.”

In addition to allocating funds to providers, the Mills administration in January opened a close supervision residential facility to provide an alternative to incarceration or hospitalization, opened a crisis center in Portland and expanded crisis support for youth based on a pilot program in Aroostook County, according to a spokesperson.

Increasing funding to providers and increasing the number of beds for in-patient treatment will help, but Michaud said it’s important to also start thinking about different methods of providing care.

“There’s not enough money in all the government to take care of this so we’re going to have to do both: We need more resources … but we also need different ways of looking at it in terms of models,” Michaud said.

Disappearing psychiatrists

Between 2015, and 2020, the number of practicing licensed psychiatrists in Maine dropped by half to 110.

The drop-off is due in large part to a wave of retirements that was hastened by the pandemic, Durst said. The average age of a psychiatrist in Maine is 55.

But Durst added that there seems to be renewed interest in psychiatry and she’s seen impressive applicants for training programs.

Maine Medical Center runs the state’s only psychiatric residency program, which offers four years of postgraduate training. There are five residents in the standard program and three in child psychiatry. The program was expanded this year to include two residents in a rural track in Rockland.

There’s a lot of evidence that people from rural areas or are trained in rural areas are more likely to stay there, said John Gale, a senior research associate at the University of Southern Maine and the former president of the National Rural Health Association.

Experts said it’s important to have providers in rural areas because they have local knowledge and understanding of what their patients are experiencing, and are better able to connect and treat them. In addition, it’s difficult for people to drive hours from home, spending time and gas money, to receive these services.

Gale said the shortage of workforce professionals and mental health services has existed for his entire 40-year career in the field. There’s been some progress but it hasn’t solved the problem.

“We’re not likely to produce enough psychiatrists and social workers who want to go to rural communities to fill the need, so I think we have to think about it differently than we used to,” he said.

Telehealth is one way to improve access but it’s a “double edged sword,” said Ng, with Acadia Hospital. While it may bridge the gap for people who live in areas without local mental health services, telehealth also means that Maine-based psychiatrists could work remotely in other places. In addition, not everyone has broadband to support telehealth communications.

Experts told The Maine Monitor that one of the most important solutions is to weave mental health services into primary care, school-based programs and community support.

This is a chance to be more proactive and work on stress reduction, rather than wait for problems to get so severe that they need to see a psychiatrist, Ng said.

“This is time for us to look at new ways to work with communities, rather than the old-fashioned way of just putting more people out there to see more patients.”

If you or someone you know is affected by any of the issues raised in this story, call the Maine crisis hotline at 888-568-1112 or text the national crisis text line at 741741. You can also dial 988 to be connected to the hotline.

Rose Lundy covers healthcare for The Maine Monitor. 

rose@themainemonitor.org.