Like most health care organizations, Franklin Memorial Hospital is a place hugely impacted by the Affordable Care Act, what many call Obamacare. One of those impacts is a change in federal reimbursements — something that affects all hospitals, but especially those serving rural communities.

And when we combine these reimbursement changes — intended to help pay for expanded coverage among the uninsured — with the decision in Maine not to fully leverage federal Medicaid dollars through the MaineCare program, the impact on our hospital and many others in Maine is devastating.

Franklin County needs Franklin County Memorial Hospital, and we are working night and day to find ways to provide top-notch health care in the new payer environment. It has not been easy and our hospital, and its parent, the Franklin Community Health Network, are in a challenging position.

The issue of MaineCare expansion has been a hot-button topic politically in Maine for some time. As a Republican and fiscally conservative individual, it is fair to say I have generally sided with Gov. Paul LePage and opposed MaineCare expansion.

However, recently, I spent some time with Republican Sen. Tom Saviello of Wilton in an effort to understand his bill, LD 633, now pending before the Legislature. After reviewing his numbers, and reading a number of analyses and articles from other states that have moved in a similar direction, I am persuaded this bill is different and would clearly be beneficial to the health of Maine people and downstream, to the health care systems that care for them.

Sen. Saviello’s bill is a thoughtful approach that would expand Medicaid to Maine’s neediest, while also providing coverage for the working poor through private insurance coverage. Importantly, the bill requires the young and able to participate financially.

I have always felt it was important for people to have a financial stake in their health care decisions, whether they are covered by Cadillac plans, Medicaid or Medicare. One of the reasons the cost of health care has ballooned over time is that people with good plans and low deductibles have had no incentive to ask questions and make decisions about their care. When someone else pays, why be invested? Saviello’s bill addresses that issue in a reasonable and thoughtful manner.

Preventative care for young people and young families makes an enormous difference in the long-term cost of care. MaineCare expansion would have a clear and immediate impact on access to care by young people. As an aside, I note the epic drug problem we face. Many of those who are drug dependent have no insurance to pay for treatment. This scenario is costly for communities, for patients and for hospitals alike.

The recently released fiscal note on LD 633 shows that it would cost the state $93.1 million over three years — an amount equal to about 1 percent of state expenditures over that period. In that time, the federal government would pump nearly $1.2 billion into the state. That money would ripple through the state’s economy in the form of increased employment in the health care sector, as well as savings on private insurance premiums.

It would be especially meaningful to Franklin Memorial. By 2019, our hospital will have contributed more than $10 million to fund expanded coverage under the Affordable Care Act through reduced federal payments. Those reductions in federal reimbursements to the hospital were to be offset by $10 million in new insurance revenue, of which $3 million was supposed to be derived from MaineCare expansion.

The fact is Franklin Community Health Network is providing more free care than ever — $1.8 million last year alone.

We don’t provide this free care passively. When we can, we help those patients who qualify to sign up for health insurance on the federal exchange created under the Affordable Care Act.

But there is a large group of very low-income patients — many of whom have significant health care needs, such as mental illness, diabetes and, as noted above, drug abuse — whose incomes are too low to qualify for subsidies on the exchange. Unfortunately, in Maine they also don’t qualify for MaineCare.

LD 633 will provide coverage to many of these people who are falling through cracks, and not insignificantly, it will bring a measure of personal responsibility to those who are and ought to be able to contribute to the cost of their care.

I encourage lawmakers in Augusta to look beyond the political barriers that have been created around this issue. Lawmakers should look hard at the numbers and people in their districts. I respectfully request that they support this bill.

Clinton Boothby is chairman of the board of directors of Franklin Community Health Network.

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