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.”

Mental illness did not prevent the Lewiston shooter from getting access to multiple guns

Echo report published in The Maine Monitor by Samantha Hogan, David Dahl and Rose Lundy:

Mass shootings at a bowling alley and bar that left 18 people dead in Lewiston on Wednesday (October 25) evening have brought Maine’s complicated relationship with guns and how to regulate them to the forefront once again.

In the past three years, state lawmakers proposed nearly four dozen bills to regulate the sale, carry and liability of guns in Maine, but most have not passed the Legislature. A “yellow flag” law enacted in 2019, lets law enforcement take guns away from someone they suspect of posing a threat to themselves or others, but officials concede it is underutilized.

Maine ranks in the middle of the pack among other states when it comes to gun safety laws, according to Everytown for Gun Safety, a gun control group, and the laws in place appeared to have done little to stop the suspect in the mass shooting in Lewiston.

Maine does not require a permit to carry a firearm in most cases. State lawmakers have rejected proposals for background checks and limits on accessories that make guns more easy to shoot. It also does not have a ban on assault weapons, unlike two other New England states.

Kristen Cloutier (Democrat), who lives in Lewiston and is the Assistant House Majority Leader, said the shooting in her hometown was “surreal and heartbreaking,” and called for “bold” legislative action to address gun violence.

“This has only strengthened my own resolve to do whatever I can to help prevent similar tragedies like this from happening again in other communities. As a state, we must do more to address gun violence and keep ourselves, our families, our friends and our neighbors safe,” Cloutier wrote in a statement to the press.

“Words are not enough — they never have been. We must take bold action,” she added.

The Maine Gun Safety Coalition immediately called on state lawmakers to pass an assault weapons ban calling the events in Lewiston “horrific, senseless tragedies.”

Rep. Rebecca Millett (D-Cape Elizabeth), a member of the state’s Gun Safety Caucus, said it was very difficult to talk about the mass shooting in Lewiston, after spending years fighting “bad gun bills” and trying to advance gun safety laws.

“The years I had to listen to my colleagues stand and say we don’t need gun safety legislation and Maine is the safest place in the country. To have my worst nightmares happen, is just devastating,” Millett said in an interview with The Maine Monitor.

Rep. Jared Golden (D) Maine second district Congressman

In another development, US Rep. Jared Golden, a Lewiston Democrat, told a news conference Thursday evening he would drop his opposition to an assault weapons ban that has stalled in Congress.

“I have opposed efforts to ban deadly weapons of war, like the assault rifle used to carry out this crime,” Golden said. “The time has now come for me to take responsibility for this failure, which is why I now call on the U.S. Congress to ban assault rifles, like the one used by the sick perpetrator of this mass killing in my hometown of Lewiston, Maine.”

Details emerge about man alleged to have shot 18 people:

A manhunt was underway Thursday by police to find the man suspected of firing multiple shots at two locations, killing 18 and wounding 13. Photos released by law enforcement show a man carrying a semiautomatic style rifle.

The suspect, Robert R. Card, 40, of Bowdoin, has a history of mental health problems and is a trained firearms instructor, according to the Associated Press.

Card is a petroleum supply specialist and Sgt. 1st Class in the Army Reserve, a spokesperson for the U.S. Army confirmed to the Portland Press Herald Thursday. The spokesperson told the newspaper that Card enlisted in 2002 and has received multiple awards but has not been deployed in combat.

The Sun Journal reported that Card had spent two weeks at a mental health facility this summer. It is unknown if Card was voluntarily admitted or involuntarily committed to the facility.

People who are involuntarily committed to a psychiatric hospital by a district court may not own or possess firearms in Maine, according to state law. Violating the law is a class D misdemeanor crime.

The Associated Press reported Thursday that police took Card for an evaluation in mid-July after military officials grew concerned about his erratic behavior while he was training with the U.S. Army Reserves at the Military Academy at West Point in New York, according to an official who spoke to the AP, on the condition of anonymity because they were not authorized to publicly discuss the information. The official told the AP that military commanders called the New York state police, who took Card to the Keller Army Community Hospital for evaluation.

When asked at a press briefing why Card was able to access a gun despite his reported history of mental health challenges, Mike Sauschuck, commissioner of the Maine Department of Public Safety, said “those are all valid questions and certainly questions that we are looking into now, but not questions that we can answer today,” given the ongoing manhunt.

Maine grapples with foreseeable harm

Maine legislators passed the “yellow flag” law in 2019, that allows police to petition a court to remove guns from a person that a medical expert says presents “a likelihood of foreseeable harm” to themselves or others either because of suicidal or violent threats against others.

The Associated Press reported that Maine’s yellow flag law is weaker than so-called “red flag” laws found in some 20 other states. The Maine law requires police first to get a medical practitioner to evaluate the person and find them to be a threat before police can petition a judge to order the person’s firearms to be seized, the AP said.

It was not clear Thursday if the law came into play regarding the suspect in the Lewiston shooting.

Maine’s yellow flag law is underused, police acknowledge. Maine Public Radio reported that the law was used two dozen times in the first two years it was in effect. Earlier this year, law enforcement noted that the law is “not being used on a regular and responsive basis” and cited a lack of available medical professionals to complete the assessments, according to a report.

Barbara Cardone, spokeswoman for the state judicial branch, said Thursday involuntary commitment orders and petitions under the “yellow flag” law are confidential court records. She declined to say whether any such court records existed for Card.

“All of these kinds of records are confidential, so I cannot provide you with any information,” Cardone wrote.

Edward Davis, who was Boston’s police commissioner during 2013 Marathon bombings, said the weapon in photos released by police appeared to be an assault-style rifle, most likely an AR-15 or an M-4, which is the military version of the AR-15.

Davis, who now runs his own security company, noted that he spends time in Maine and has had tense conversations with Mainers about gun ownership.

“I have guns, but they need to be regulated,” Davis said in an interview with The Maine Monitor.

The suspect in the shootings, Card, has a history of mental health problems. “We should have an absolute prohibition on anybody like that having guns,” Davis said.

Maine will now grapple with how to respond to one of its worst mass casualty events.

Similar shootings have shaken the country, including the 2022, Buffalo grocery store shooting that killed 10, and the 2021, spa shooting spree in Atlanta that killed eight people.

“We continue to monitor the horrific situation in the greater Lewiston area as the manhunt is underway for the person of interest in the Lewiston mass shooting. We grieve for the families of the 18 who were killed and 13 injured in this senseless tragedy,” Maine House Republicans said in a news release on Thursday.

Stephen King, famous Maine horror and science fiction author, said on X, formerly known as Twitter, Thursday morning that these kinds of shootings don’t happen in other countries.

“The shootings occurred less than 50 miles from where I live,” he wrote to his 7 million followers. “I went to high school in Lisbon. It’s the rapid-fire killing machines, people. This is madness in the name of freedom. Stop electing apologists for murder.”

A tired fight for change

Everytown For Gun Safety, a gun safety advocacy group, ranked Maine 25th in the nation in terms of gun laws.

Maine law prohibits any person convicted of a crime and sentenced to a year or more in prison from possessing a firearm. People under a protection from abuse order for harassing, stalking or threatening an intimate partner or child also may not possess a gun.

State lawmakers in recent years have rejected ideas to prohibit people from possessing “rapid-fire modification” devices for guns that increase the number of bullets that can be shot at one time or to require background checks for purchasers at private gun shows.

Maine lawmakers also rejected a proposed background check exemption for people with concealed weapons permits when they go to purchase a firearm, and legislation that would regulate the manufacture, distribution and possession of “untraceable and undetectable” firearms.

A proposal that would allow certain people to carry concealed handguns on school property narrowly failed in the Maine Legislature in June.

Several more pieces of gun legislation are expected to be discussed by lawmakers next year when the Legislature reconvenes in January.

Millett, the lawmaker from Cape Elizabeth, has a bill that would allow a person to bring a civil lawsuit against gun manufacturers for selling “abnormally dangerous” guns, because the product was “most suitable for assaultive purposes” rather than hunting, self-defense or sport, or because it converts a legal firearm into an illegal firearm, or is marketed to minors.

She said in an interview Thursday it is time for legislators to listen to the people they represent and to be proactive about gun safety.

Still, lawmakers will face barriers to getting substantial legislation passed next year while they meet for a short time and with restrictions on the kinds of bills that can be worked on.

“We had a host of bills this past session and a good deal of them didn’t go anywhere,” Millett said. “And now that we’re in the short session there’s a lot less latitude for legislators to put in any new legislation for consideration.”

At least one proposed bill that will go to lawmakers next year would restore gun rights to some people convicted of nonviolent crimes if they are not convicted or any additional crimes and 10 years have passed. Criminal law experts have already raised multiple concerns about how the bill is written.

Ten states, including Massachusetts, Connecticut, and New York, have assault weapons bans.

On the federal level, President Joe Biden again called for a ban on assault weapons following the shooting in Lewiston.

Biden urged Congressional Republicans to work with Democrats to pass a bill that would ban assault weapons and high-capacity magazines. He also called for universal background checks, safe storage of guns and an end to liability immunity for gun manufacturers.

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.