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.

The triple impact of having an older, poorer and rural state will be painfully felt by a very large proportion of Maine’s citizens if the Affordable Care Act is repealed.

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. Such a patient might choose to opt out of health insurance due to the inability to pay. If that person decided to enroll in a health insurance program three or more months later, insurance companies could charge an additional 30 percent.

According tp the Congressional Budget Office’s estimate, the loss of insurance for 24 million Americans through the next 10 years will be felt particularly hard by Mainers, due to the older and less affluent population.

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 likelihood of a full recovery will be lessened than if they had received care earlier. The financial costs will be higher, as it will take more resources to maximize care. 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.

The loss of the local health care resource will be an additional nail in the coffin of these rural communities throughout the state. 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.

In summary, under the current AHCA proposal, people who can no longer afford to buy insurance will see their primary care providers less and will rely on emergency rooms more. The surcharge for people who have a break in coverage will increase the percentage of younger, healthier people putting off buying insurance until they get sick, driving up insurance rates because the healthy young will not be in the insurance “pool” to offset the costs of older adults with more health problems. Less preventive care will increase medical costs in the years to come.

Many Maine communities voted for the current administration because of promises of more jobs and better health care. But the current proposed Republican replacement to the ACA does the opposite. Residents of Maine, particularly those small, rural communities and the 75,000 Mainers who have their insurance through the ACA, should demand better. Maine and its citizens cannot afford to repeal the ACA.

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.

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