BANGOR, Maine — Last year, Republicans set American health care on a new path: They slashed $1 trillion from expected Medicaid funding over the next decade and allowed tens of billions of dollars in annual insurance subsidies to expire.
The full impacts of those changes won’t be felt for years, but many parts of the health care system are already racing to prepare. The scramble is most intense where the cuts are projected to land the hardest: rural states. In dozens of interviews from Louisiana to Maine to Washington, D.C., providers laid out the changes, and difficult choices, they’re making.
Maine, for example, has the nation’s highest proportion of its population living in rural areas and an above-average share of Medicare and Medicaid beneficiaries. The federal government’s planned retreat in health care has state leaders on edge — and planning a barrage of changes to how they deliver care and how they make money from it.
“We will look different moving forward,” said Lisa Harvey-McPherson, vice president of government relations at Northern Light Health, one of Maine’s large health systems. “Some services that we provide today will either look different or won’t be offered.”
Northern Light leaders have a long list of plans and contingencies. They’re working to move care away from their highest-cost facilities out to smaller facilities or even telehealth, where appropriate. They’re building up staffing and systems to help patients navigate new paperwork to get and keep Medicaid coverage. And they’re trying to plot the savings they’ll need to counter the expected increase in uncompensated care and the increased demand they’ll face as other health systems pull back or go under. They’re considering consolidations or closures that may be needed to achieve those savings.
