Maine AllCare

Maine is the most rural state in the nation. Almost two-thirds of Maine residents live in rural areas, and 11 of 16 counties are considered rural, according to a 2022 report from the Northern Border Regional Commission. Rural Maine counties tend to have higher rates of poverty, unemployment, and economic distress, lower rates of health insurance coverage, and poorer overall health. In addition, 15 Maine counties have health professional shortages in primary care, mental health, and dental health.

People who live in rural areas receive most or all of the health care services they need from small rural hospitals and health centers, which face steep financial challenges in our current health care system caused primarily by underpayment and payment systems that don’t meet their unique needs.

Rural hospitals around the country face the risk of closing, leaving many people without access to the health care they need within a reasonable distance, if at all. In Maine, more than 25% of rural hospitals face the risk of closure, including four facing immediate risk.

Recognizing rural needs

Small rural hospitals and health centers generally aren’t paid enough by any health care payers (private insurance, Medicare, Medicaid, etc.), but especially by private insurers (including Medicare Advantage). They need to be paid differently because the costs of providing care in rural areas are different than in urban areas.

It costs more to deliver health care services in rural areas, in part because rural hospitals and providers need to cover the costs of keeping facilities open and staff available when people need them, regardless of how many people use them, often called “standby capacity.”

Maine needs a payment system for rural hospitals that supports standby capacity as well as the services people use, and adequately funds primary and emergency care. Paying rural hospitals and providers adequately could also help attract more health professionals to rural areas.

How can universal health care help in rural places?

There is growing recognition, in Maine and across the country, of the health care struggles experienced in rural places. But what can be done, and how could a publicly funded, universal health care system benefit rural Maine?

By reducing administrative complexity and burden, a publicly funded, universal health care system would go a long way to keeping our rural hospitals open and sustainable.

Many economic studies have shown that universal health care would save money. In an economic analysis done by the Maine Center for Economic Policy in 2019, such a system would lower costs for most Mainers, by far, while covering everyone.

Many health care professionals today are experiencing burnout and moral injury in a system that prioritizes profit at the expense of care. A simplified, publicly funded system would allow health care professionals to focus on what they are trained to do, and passionate about: take care of people.

Separating health insurance from employment would free up workers to seek jobs based on their skills and interests rather than on which ones offer health insurance. This would benefit both workers and employers.

Businesses in rural communities provide much-needed jobs and connections for people who live in them. Covering everyone in a publicly funded system would free businesses from the burdens of navigating health insurance for their employees (as well as for their own families), and allow them to focus on growing and sustaining their businesses. Health care for all also means a healthier population.

Similarly, freeing municipalities from the costs and burdens of providing health insurance to employees would allow them to focus funds, time, and other resources on infrastructure and other community needs.

How to get there

The obstacles to a universal health care system are not economic or medical, they’re political and cultural.

In early 2023 two bills relating to rural health were introduced in the Maine Legislature: LD 904, An Act Supporting the Rural Health Care Workforce in Maine; and LD 190, An Act to Develop a Long-term Plan to Address Mental Health Needs in Rural Maine. Both bills have bipartisan co-sponsors, indicating the recognition across the political spectrum of health care struggles in rural Maine and the need for change.

These bills are an important step toward improving health care in rural Maine, and our legislators are working hard toward this end. But if we want to help businesses, workers, municipalities, health care professionals, and all who live and work in rural Maine, we need fundamental change—we need publicly funded, universal health care.