Be careful what you wish for.

Might Rumford Hospital close?

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Changes to ACA could devastate Maine hospitals

Steven Michaud - president of the Maine Hospital Association in Augusta

Sunday, January 22, 2017

Maine hospitals would stand to lose more than $3 billion over 10 years, according to our estimate that envisions a nightmare scenario where the Affordable Care Act cuts to hospitals remain but benefits to hospitals are repealed.

For this reason, Maine hospitals strongly urge Congress that there should be no ACA repeal unless there is an adequate and simultaneous replacement of its provisions.

The ACA contained both positives and negatives for hospitals. That was by design.

Obviously, none of us knows what the replacement legislation for the ACA will include.

The Maine Hospital Association's primary concern is what happens to the benefits, specifically the Exchange subsidies that account for $200 million a year in reimbursement to hospitals, and the 340b drug pricing program for Critical Access Hospitals, which saves our smallest hospitals $15 million a year.

While we’re hopeful that the nightmare doesn’t materialize, the public needs to know that hospitals simply can’t afford to lose anything close to $200 or $300 million per year. The hospital system in Maine would be crushed if the hospital cuts were to remain and the replacement was inadequate. Make no mistake, some hospitals would close and the rest would be strained to their limits. Health care workers would lose their jobs. A person's ability to see a doctor, any doctor, could be severely limited.

Changes to the ACA, even good ones, must be done thoughtfully and with care. The physician adage: “First, do no harm” has never been more instructive.

Read the entire article here.

This is just the beginning.

Central Maine Healthcare says no to Bates Mill, lays off 28

LEWISTON — In response to continued revenue losses, Central Maine Healthcare officials announced Thursday that the organization is dropping plans for a project at Bates Mill No. 5, while also laying off 28 employees at the hospital.

President and CEO Jeff Brickman said the move was in response to "uncertainty" in the health care industry, with cuts in Medicare and other factors contributing to a $12 million revenue shortfall in 2016.

The announcement is a setback for Bates Mill developer Platz Associates, which is hoping for a 2018 construction start at Mill No. 5, the largest building at the Bates Mill complex. Central Maine Healthcare was set to become an anchor tenant of the $70 million redevelopment, along with the YMCA.

He said the Centers for Medicare and Medicaid Services recently changed how services are reimbursed at hospital-owned outpatient facilities. The changes were effective Dec. 31, 2016, he said.

"Unfortunately, this change would greatly reduce the reimbursement from Medicare for operating a medical facility in the Bates Mill location," he said. "A sizable projected loss of revenue makes the project financially unfeasible."

The nonprofit CMH is the parent of Central Maine Medical Center in Lewiston, and Rumford and Bridgton hospitals, the Dempsey Center, the Central Maine Heart and Vascular Institute and a collection of medical practices throughout Central and Western Maine.

Brickman said a number of changes at both the federal and state level, combined with economic factors in Central Maine, have created the uncertainties and shortfalls in revenue.

"We're trying to buck that trend, and really take some bold steps to work through the uncertainty," he said.

SJ Link

Thank you Governor LePig.
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Brickman said one-third of the hospitals in Maine are losing money as a result of the changing industry. He said Maine is one of 19 states in the country that did not expand Medicaid as part of the Affordable Care Act.

SJ Link

Even if the Rumford Hospital does not close, there are other things to consider should the Affordable Care Act be repealed and not replaced.

Of the 300+ million Americans, just 20+ million get their health insurance (BTW, it's insurance not healthcare) through the ACA.

That means most Americans, under the age of 65, get their health insurance through their employer.

If Obamacare is repealed and not replaced, these Americans will be affected too. BTW, Obamacare and the ACA are one in the same.  Most Americans who put Trumpery in the White House don't know that.

Here are just a few examples of how all Americans will be affected if the ACA is repealed and not replaced:

Loss of pre-existing condition(s) protection
Loss of dependent coverage up to age 26
Reduced preventive care coverages
Restored annual caps
Restored lifetime caps
Higher copays
Higher coinsurance rates

And for those 65 or older on Medicare? You'll see increased costs for prescriptions, and much higher Medicare and Medicare Advantage Plan premiums.

As things are today, if the AHCA (TrumperyCare) passes as written, we can expect Rumford Hospital to close in the not too distant future.

The AHCA will do little of what Trumpery promised during the campaign, i.e., "coverage for all" that is affordable.  

Anyone earning $30,000 per year could be forced to spend 25% or more of their income if they want health insurance.  A family earning $30,000 per year could be forced to spend 40-45% of their income on health insurance.

That's not affordable.

What's ironic, Trumpery supporters have the most to lose if this bill passes.  

The AHCA offers less assistance to older and lower-income Americans, especially in rural areas. Older and lower-income people backed Trumpery more than any other demographic. Most of all, Trumpery’s white working-class supporters often make enough money to be ineligible for Medicaid, but not enough to afford costly health insurance that will be even more expensive under the AHCA.

If the AHCA does not pass, it will be because the bill does not go far enough in making health insurance less affordable for low income earners.

If the AHCA does pass, lower income earners will be forced to give up health insurance and move to charity care (the wealthy will see significant savings).

Significant increases in charity care may force CMH to close Rumford Hospital.

Be careful what you wish for.

BTW...if you think for one second that taxpayers don't pay for "charity care", you're nuts.

Two of the biggest issues Republicans, Tea Partiers, and Trumpery supporters have with the ACA are:

1. Fines on people who refuse to carry health insurance
2. Subsidies to help pay premiums for low income people who can't afford health insurance

If these two are items are not included in any reform of the ACA, or are not included in any replacement, millions of people will move to charity-care.

U.S. Congressman Ron DeSantis-R said on CNN: "If people really need it (health care), if they show up to the emergency room, they do get care, it just gets passed on to other folks."

And who do you suppose those "other folks" are?

Charity-care is a lot more expensive than health insurance. Health care costs will go up as will our taxes.

The CBO has released its analysis of the American Health Care Act (TrumperyCare).  

If passed:

*14 million people will lose health insurance coverage next year.

*24 million will be without health insurance coverage by 2026.

Trumpery supporters, who ironically will be most affected by this bill, will dismiss the CBO analysis.

Why?

Because it's FAKE NEWS, of course.

Charity-care will explode, and so will your tax bill.

But, not to worry.  The wealthy will make out like bandits!

CBO

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Even though Trumpery (in anticipation of a negative CBO analysis of the TrumperyCare bill) launched in advance an anti-CBO smear campaign, the:

CBO is strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence without regard to political affiliation. CBO does not make policy recommendations, and each report and cost estimate summarizes the methodology underlying the analysis.

Republicans are trashing the CBO report, citing that certain CBO estimates of the ACA were off by 30%.  The CBO was wrong then, so must be wrong now.  

BUT, these same Republicans fail to mention that the CBO's estimates were off due to the Supreme Court's decision regarding Medicaid expansion, not because of its methodology.

ALSO, the CBO analysis of the ACA was the most accurate of ANY analysis that was done by anyone.

Funding cuts would damage hospitals

by David Frum and Timothy Churchill

We are deeply concerned and distressed that the Legislature is once again debating additional Medicaid cuts to hospitals. The latest round of cuts proposed — totaling more than $60 million per year — is unsustainable. More importantly, they are unnecessary.

We manage four hospitals in the relatively small Maine communities of Bridgton, Rumford, Norway and Farmington. We cover the territory from the Sebago Lakes region to Sugarloaf and all points west to the New Hampshire border.

Our hospitals help provide the backbone of health care in rural Maine. We employ thousands of Mainers and are among the largest employers in Franklin and Oxford counties. Together, we provided approximately $4 million worth of free medical care to members of our communities.

Four years ago, when the Medicaid program was not as stable as it is today, the Legislature cut Medicaid eligibility — disenrolling tens of thousands of people, raised taxes on hospitals and cut hospital reimbursement. Those were difficult decisions for the Legislature to make and even more difficult for our hospitals to absorb.

As a result, Maine’s 36 hospitals have received $70 million less per year from Medicaid compared to four years ago.

However, care and expenses for treating patients on Medicaid have not declined during that period. In fact, the pharmaceutical costs that hospitals incur in treating individuals on Medicaid have increased more than 25 percent during the same four-year period.

Thanks to a lot of hard work by hospitals and others, the Medicaid program is now financially stable. An example of that hard work involved a partnership with the Department of Health and Human Services which oversees the Medicaid program.

Hospitals, however, are not in a stable condition.

Read the rest of this editorial here.

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David Frum is president and CEO of Bridgton Hospital and Rumford Hospital. Timothy Churchill is president and CEO of Western Maine Health and interim president and CEO of Franklin Community Health Network.

Remember what happened in 2008-09?  When people were so pi$$ed off that Obama was elected?

Remember how pi$$ed off people were when the ACA was pushed through "in the dark of night"?

Remember how pi$$ed off people were, so much so, the Tea Party was created which ultimately led to the election of Trumpery?

Well, people are pi$$ed off again.  But, it's a different, much larger group.

Republicans are ignoring the history of the last 8-10 years, and they are condemning themselves to repeat it. This time they will be the losers.

There are parts of the ACA worth saving.  There are parts of the AHCA worth implementing.

Idology must be abandoned, and compromise promoted so that a plan that helps all American citizens is implemented.

Increasing "access" to a system (Republican position) that no one can afford (Democrats' position) is not improving health care.

Republicans keep screaming ACCESS, ACCESS, ACCESS!!

The AHCA does not provide any more access to health insurance than does the ACA.  In fact, the AHCA provides less due to reduced government subsidies to help lower income people purchase insurance.

If you're self-employed and between the ages of 40 and 64, good luck finding the funds to purchase health insurance under the AHCA.

Under the legislation (AHCA-TrumperyCare), insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law (ACA-ObamaCare), substantially reducing premiums for young adults and substantially raising premiums for older people.

So in effect, insurers will charge more and the government will provide less financial support (subsidies) for older people.  It is not clear...yet, how the AHCA will affect premiums for enrollees who get their insurance through their employer.

I am hearing this analogy all the time now: We all have the option to buy a Rolls Royce, but how many of us can afford one?

Certainly the wealthy can, especially if the AHCA passes as written.  The wealthy will reap a windfall of over $300 billion, while many of the self-employed, between the ages of 40 and 64, will be forced to move to charity-care.

Trumpery supporters (the AHCA is gonna hurt you the most), be careful what you wish for.

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Mainers cannot afford proposed health care replacement plan

Elizabeth Rothe, MD                                            
Sunday, March 19, 2017

As a practicing family medicine physician in Lewiston, I am concerned about the fate of the Affordable Care Act. The repeal of the ACA and its replacement by the proposed Republican Healthcare Bill would be extremely detrimental to the citizens of Maine, particularly those in central Maine.

Maine has the oldest population in the country, with nearly 20 percent of Maine residents over the age of 65. Additionally, it is the poorest state in New England and, arguably, the most rural. Consequently, a large proportion of the state’s population obtains its health care from small, rural hospitals and clinics. Rumford Community Hospital and Stephens Memorial Hospital in Norway are two central Maine hospitals that have been designated as two of the 16 “Critical Access Hospitals” by the state, which are vital to the health of rural and underserved populations.

Under the Republican plan, insurance companies could charge older subscribers up to five times what a younger individual would pay. The Kaiser Family Foundation estimates that a 60-year-old in Androscoggin or Franklin County making $30,000 a year would potentially have to pay nearly $5,000 more annually for health insurance under the proposed Republican plan compared to the ACA, with a 55 percent decrease in their tax credit.

In my practice, I have seen many patients without insurance who put off seeking health care because of cost until they become too sick to wait any longer. They may end up in the emergency room, which may be a small, rural hospital that will treat them regardless of their ability to pay.

The hospital will take a financial loss because they won’t be reimbursed for their care. Multiply that case by several hundred patients, and the cost to those small hospitals could soon add up to millions of dollars.

Under the proposed Republican plan, hospitals may survive this by making cuts, or they may choose to close their doors altogether, resulting in huge repercussions to the community, given that hospitals are often the largest local employers. Unemployment will rise and the rate of the uninsured will increase.

A total of 57 rural hospitals have closed in the U.S. since 2010 (two of them in Maine) mostly due to financial pressures. Rural hospitals face many challenges and those in states that have not expanded Medicaid are feeling the most financial pressure.

Read the entire editorial here.

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Elizabeth Rothe is a board-certified family medicine and sports medicine physician, practicing at Central Maine Family Medicine Residency as a faculty member and for eight years at Central Maine Sports Medicine in Lewiston. She is a member of Maine Providers Standing Up For Healthcare.

FYI

Presently, the average annual cost per Medicaid enrollee is roughly $4000.  Under TrumperyCare it will nearly double to more than $7000.

Don't ya just love having a "businessman" running the country!

Trumpery must be using LePig math!

Dr. Price said today, that under the ACA, people do not have access to health care due to high deductibles.

So, what's Dr. Price's alternative?

Make health insurance so expensive, fewer people have access to health care.

I have a rhetorical question.

Why haven't we had a discussion as to why health care (not health insurance) is so expensive?

I never hear our politicians talk about it.

Trumpery: "Nobody knew that healthcare could be so complicated"

Trumpery: "I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."

Trumpery: "They're going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably --"

Trumpery: "The government's gonna pay for it. But we're going to save so much money on the other side. But for the most it's going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything."

Trumpery: "We're going to have great plans. They're going to be much less expensive and they're going to be much better because the Obama plan is unaffordable and it's a disaster… But there will be a group of people that is not doing well, that has no money."

Trumpery: "We cannot let them die in the streets. And we'll work out either through Medicare, which we'll save or something… And I say to the Republicans all the time. And by the way I get standing ovations from Republicans, from Republican groups. I got one yesterday. I said we can't let people die in the streets… We're going to take care of them. We're going to take care of them. We have to take care of them. Now, that's not single payer. That's not anything. That's just human decency. And I'll tell you what. Every single time I say that, I say to people in the audience -- I say, 'So what do you think?' They all stand up and give me a standing ovation, OK?"

Trumpery: "Excuse me. We are going to take those people and those people are going to be serviced by doctors and hospitals. We're going to make great deals on it, but we're not going to let them die in the streets."

Trumpery:"Obamacare. We're going to repeal it, we're going to replace it, get something great. Repeal it, replace it, get something great!"

Trumpery: "If you can't take care of your sick in the country, forget it, it's all over. I mean, it's no good. So I'm very liberal when it comes to healthcare. I believe in universal healthcare. I believe in whatever it takes to make people well and better."

Trumpery: "There's many different ways, by the way. Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, 'No, no, the lower 25 percent that can't afford private'… I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."

Senator Susan Collins said today, that under TrumperyCare, a 60 year old earning $26,000/yr will see his/her health insurance costs go from $1,700/yr to $14,600/yr.

Even with a tax credit, his/her insurance costs will be at least $12,900/yr.  That's 50% of his/her income going to health insurance.

That's not affordable.  The only option will be charity-care.

The latest Quinnipiac poll reports that:

* 56% of Americans oppose the AHCA
* 17% of Americans support the ACHA
* 60% disapprove of Trumpery's handling of health care

The following organizations oppose the AHCA:

The American Medical Association
American Nurses Association
American College of Physicians
National Nurses United
National Physicians Alliance
Association of American Physicians and Surgeons
American Academy of Pediatrics

The AARP
American Hospital Association
Federation of American Hospitals
America's Essential Hospitals
Families USA

Heritage Action
Cato Institute
Americans for Prosperity
FreedomWorks
Tea Party Patriots
Club for Growth

It appears "repeal and replace" is gone.  Trumpery and McConnell have decided to let the ACA collapse under its own weight.  They predict the Democrats will come running to them when it does.

Now is the time for the Democrats to step up and fix the ACA before it does what every Republican hopes.

Trumpery: "I'm a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by health care expenses. We must have universal health care. The Canadian plan helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. We need, as a nation, to re-examine the single-payer plan, as many individual states are doing."

From "The America We Deserve" in 2000
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So, which is the real Trumpery?  When you are a con-man, it's very difficult to know.

Trumpery and the Republicans are making another attempt to screw their supporters.
 
One of their latest ideas (to cut health insurance costs) is to allow insurance companies to charge sick people more to lower the costs for healthy people.

What an idea!

But I have a better one.

Why don't we allow insurance companies the option to deny insurance to anyone who could possibly get sick in the future?  That way they can insure just healthy people, reduce their risk to near zero, and make more money.  After all, that's what Republicans and Trumpery are all about... making more $$$., right?  

Makes sense to me.

As of 5/2/2017, the following organizations oppose the latest Republican health care bill and favor fixing the ACA (Obamacare):

American Hospital Association
American Medical Association
American Academy of Family Physicians
American Academy of Pediatrics
American College of Physicians
American Congress of Obstetricians and Gynecologists
American Osteopathic Association
American Psychiatric Association
American Cancer Society Cancer Action Network
American Heart Association
American Diabetes Association
American Lung Association
March of Dimes

The biggest concern is what Trumpery and the Republicans are proposing with regard to pre-existing conditions.  No matter what Trumpery said in interviews yesterday, coverage for it is not in the bill.

The latest draft of Trumpery's bill would allow states to obtain waivers of the ACA pre-existing condition provision that requires insurers to charge people with medical problems the same premiums that healthy people pay.

And we all know that LePig and Maine's Republicans would seek to obtain that waiver.

Right?