U.S. Senator Angus King hears local hospital concerns about Affordable Care Act repeal
By Wayne E. Rivet
Rather than simply listening to politicians talk about what effects repeal of the Affordable Care Act will have on the country, U.S. Senator Angus King returned home to find some answers.
One stop was Bridgton Hospital last Friday. Meeting with hospital administrators and physicians, Sen. King started the roundtable discussion with a simple comment, “Tell me what I need to know” about opioids abuse and health insurance coverage.
He heard plenty.
Dr. Craig Smith said when he arrived here 12 years ago, he was “surprised to see what people were struggling with here,” in terms of drug abuse. Seeing the number of cases grow and grow, Dr. Smith became licensed to treat patients with suboxone. He also added a counseling piece to help patients turn their lives around.
“Have you seen successes?” Sen. King asked.
Dr. Smith replied, “Absolutely. We’ve seen people go back to work, go back to school. Yes, there can be relapses. But, people get to a place where they don’t want to go back.”
One barrier keeping some people from treatment, Dr. Smith said, is insurance coverage.
“Costs of treatment can keep people from coming in. We try to get those with no insurance some coverage, but their perception is that if they can’t pay, they can’t get help,” Dr. Smith said.
Three local physicians are working with suboxone, and do have openings.
“The real tragedy is that when someone gets to the point they want to get help and they can’t get in,” Sen. King said.
Bridgton Hospital Board Chairman Phil Libby never thought he would hear “Maine” and “heroin” used in the same sentence.
“That problem wasn’t ours, it was in the big cities,” he said.
Sen. King felt there was a stigma about drug users, but today, those entangled by opioid addiction come from all walks of life and all age groups.
When Dr. Wenda Saunders started her pediatric practice 25 years ago, Bridgton Hospital had a “low level” of care. Mothers using opioids were sent to bigger hospitals for delivery “because of the monitoring (of babies) and training needed by the nursing staff.”
“We felt it was unfair for mothers to not be able to deliver locally,” Dr. Saunders said. Today, mothers using suboxone can deliver at BH.
Central Maine Healthcare system-wide, 25 to 30% of babies delivered last year had moms who were using opioids or suboxone, Frum reported. If marijuana is added, the numbers increase further.
Finding a “prevention tool” that works is something politicians and law enforcement continue to search for. Dr. Smith said the key still remains early education.
“My sense is that people choose to do it (use drugs) the first time, but then they have no chance after,” Sen. King said.
Dr. Smith agreed. Drug use “hijacks” brain function, especially decision-making. People no longer think rationally, but focus more on the need (more drugs) right now.
“Let me know how I can help,” said Sen. King, who noted he heard the disturbing statistic that a person dies each day due to drug abuse.
Conversation then switched to effects of ACA repeal.
Early last Thursday morning (2 a.m. to be precise, Sen. King noted), the Senate voted 51-48 to repeal. Sen. Susan Collins voted in favor of repeal, while Sen. King offered an amendment to continue healthcare coverage for workers who work in particularly high-risk industries such as forestry, farming, fishing and law enforcement. His amendment failed, 50-49.
(Update: According to Christopher Knight, press secretary for Senator Collins), she did not vote in favor of repealing the ACA. She voted on budget reconciliation instructions that would allow Congress to begin considering a serious replacement to Obamacare. “Senator Collins has called for the creation of a detailed framework that would protect Americans from losing their health insurance coverage and avoid turmoil in the insurance industry prior to repealing the ACA,” Knight said. Senator Collins introduced her own comprehensive replacement plan, the Patient Freedom Act, with Senator Cassidy last week.)
What impact would ACA repeal have? According to hospital officials:
- More than 75,000 Mainers will lose healthcare coverage. These are people who don’t qualify for Medicaid and can’t afford insurance on the private market.
- Of those 75,000 people, 11,000 will lose mental health coverage and 8,000 substance abuse help.
- Hospitals will feel a significant financial impact since Maine is one of 19 states that did not expand Medicaid under the ACA.
- 40,000 Mainers lost Medicaid over the last couple of years.
- Under the current state budget proposal, another 20,000 would be cut from Medicaid and reduces funding to critical access hospitals, such as Bridgton Hospital.
David Frum, president and CEO of Bridgton Hospital, told Sen. King that in the absence of an ACA alternative, thousands of Mainers will be without health insurance.
“It could have a catastrophic effect on this (financially) sound institution,” Frum said. Loss of insured patients and increases in charity care would force hospitals to alter levels of service. “That’s not where we want to be, but it’s the only place you can be if you lose that revenue base.”
Sen. King said some other Maine rural hospitals are right on the edge of closure. Frum was not surprised, knowing a third of small critical hospitals are operating at a loss. He added the threat is real that some facilities will fail.
Doctors feel people suddenly without insurance coverage will either not seek medical help or scale back medication to save money. The end result is greater and more expensive medical problems down the road.
Dr. Shayna M. Lemke, who serves as a hospitalist at Bridgton Hospital, had one case that stands out. A patient in his 30s works two part-time kitchen jobs. He is “very responsible,” Dr. Lemke said. He has no insurance.
So, when he experienced weakness in his legs, he hoped the condition would improve, since he couldn’t afford to go to the hospital to be checked. It didn’t improve.
“He was using the stove and equipment at the restaurant to move and get to where he needed to go. His boss said it was time for him to be checked,” the doctor said.
A tumor was discovered. It was causing paralysis.
“This should not happen,” Dr. Lemke said.
Dr. Saunders feel loss of coverage will result in parents not having children vaccinated, especially against some diseases that have attempted to make comebacks.
Sen. King knows personally the importance of preventative care. A checkup uncovered melanoma on his back.
“If you don’t catch it, you’re a gonna,” he said. “It’s always haunted me that I had insurance that saved me.” Some guys don’t and likely face fatal outcomes. “How is this fair?” King asked.
Sen. King understands the need to rework aspects of the Affordable Care Act, but to simply repeal it with no alternative in place makes little sense to him.
Frum noted that Bridgton Hospital has received both state and national accolades for providing high quality care and service at a low cost.
“If you pull away the payment mechanism, that’s fine, we’ll still be providing those three aspects, but you can’t sustain it,” Frum noted.
Sen. King encouraged Frum and other Maine hospital administrators to reach out to colleagues in other states to apply pressure on their political leaders regarding pushing for continued healthcare coverage for all Americans.
The full conversation with Sen. King can be viewed on Bridgton Hospital’s Facebook page.