Many experts have pointed out how devastating the Republican Health Care bill will be for Maine’s working people. But few have noticed that another major victim of Trump Care will be our state’s rural hospitals. 

Maine’s rural hospitals are already struggling. According to the Portland Press Herald, many of Maine Health’s local hospital networks ran in the red in 2016. These include those serving Knox, York, Franklin and western Oxford counties. 

The Republican bill repeals the Affordable Care Act which helps 80,000 Mainers pay for their health insurance. Their new system will make health care insurance so much more expensive that, except for the well-off, tens of thousands will no longer be able to afford health insurance.

The problem for Maine’s rural hospitals is that many of the people who will lose their insurance live in the state’s rural counties and towns. If these Mainers don’t have insurance, many will forgo going to the doctor or the hospital, even when they need to. Without these patients, rural hospital revenues will fall. The Maine Hospital Association estimated that Maine’s hospitals receive about $200 million a year from ACA-subsidized insurance policies.

Not only will hospitals suffer from reduced revenues, but their costs will also increase. Under state law, hospitals have to provide emergency treatment for people whose incomes are below 150 percent of the federal poverty level. Most hospitals in Maine have other programs to help those unable to pay, but the burden on hospitals will multiply under Trump Care. Every hospital will be forced to write off increasing amounts of what are called “uncompensated care” and “bad debts.” 

To protect themselves from this economic squeeze, rural hospitals will have to cut costs and that will inevitably mean reducing or eliminating health services they have been offering. The Maine Center for Economic Policy reported that if the ACA is repealed without a suitable replacement, uncompensated care in Maine could rise to $475 million in 2019.

In future years, the situation will get even worse. The Republican plan includes provisions that will eventually result in cuts to Maine Care, the state program offering health care for low income people. As that program is cut, hospital revenues will decline further while uncompensated and free care costs will rise. Trump Care will create a perfect storm for Maine’s rural hospitals.

The plan that Ryan and Trump are pushing through Congress will hurt small rural hospitals throughout the country, including those in “red” states like Montana, Wyoming, South Dakota and North Dakota. But Maine will be hit the hardest. This is because Maine has a higher proportion of older people. And the areas of the state that will suffer the most are the northern and eastern counties, where the mills have closed, incomes are low, and the population is older. It is interesting to note that these areas also tend to the “reddest” areas of the state. 

Lee Webb, Union