Jeffrey S. Barkin, MD, DLFAPA, is a practicing psychiatrist in Portland and the former president of Maine Medical Association. He co-hosts “A Healthy Conversation” on WGAN.

Health insurance is supposed to be the quiet partner in our lives. It is like the foundation of a house — steady, unseen, reliable. You rarely think about it until it shifts beneath you. And right now, in Maine and across the country, people feel that shift every day. They feel it in appointments pushed months out, in bills they never expected, and in the unsettling fear that their doctor or hospital might vanish from their network with a single letter in the mail.

These fears are not partisan. They do not belong to one ideology or another. They are simply real. And they grew sharper this year when Anthem, one of Maine’s largest insurers, and Northern Light Health, one of our major health systems, came perilously close to a split.

For months, families across Maine lived suspended in uncertainty. Would their insurance still cover the hospital where they gave birth? The cancer center that saved their father’s life? The therapist who finally helped their child grow? No one could answer those questions. And the not knowing inflicted its own kind of harm.

Thousands of Mainers endured stress no household should face — wondering whether the care they rely on would still be there tomorrow. This near-breakup revealed a stark truth: insurers can threaten to walk away from entire communities with almost no warning, leaving patients to bear consequences they did nothing to create.

This is not uniquely Maine’s problem, nor is it born from any one political philosophy. Across America, insurers have stepped out of rural counties, midsized regions and even major cities the moment profits tighten. They call these actions “market adjustments.” But for the people left behind, it is abandonment in plain language.

In my psychiatric practice, I see the emotional toll. A mother who spent years finding the right developmental specialist for her son worries that a contract dispute will erase that relationship. A cancer survivor lies awake wondering if her surgeon will remain in network after New Year’s. A retired millworker treats every insurance envelope like a potential eviction notice.

These stories are not ideological. They are human. And they underscore a hard truth: our system allows instability without accountability.

A few years ago, an entire Western county lost its only Affordable Care Act insurer overnight. Some families drove hours through mountain passes simply to learn whether they still had coverage. Others discovered that the nearest specialist willing to take their new plan lived more than 150 miles away. For people with chronic illness, this was not disruption. It was collapse.

Closer to home, a New England health system structured much like Maine’s lost a major insurer suddenly. Patients who had done everything right — kept their appointments, followed their treatment plans, stayed in network — found themselves holding appointment cards for doctors they might no longer be permitted to see. A man with heart disease feared his next visit would wipe out his savings. A woman in chemotherapy asked, “How do I start over in the middle of treatment?”

When insurers walk away, care doesn’t erode gently. It tears apart at the seams — always where people are least able to withstand it.

There is a clear, bipartisan solution that protects patients, stabilizes hospitals and removes the nuclear bargaining tactic insurers now hold.

If a health insurance company leaves a region of Maine — or withdraws from one of our three largest health systems — it should be barred from returning for 20 years.

Twenty years is not retribution. It is responsibility. It says: if you want to serve Maine’s people, you must commit to Maine’s people. You cannot exit when profits dip and reenter when conditions improve. You cannot treat patients like disposable line items. Leaving the market must be a sober, rare decision — not a negotiating strategy.

Some may call this approach heavy-handed. Others may say it doesn’t go far enough. But Mainers of every political background agree on one principle: the care you depend on today should not vanish tomorrow. Stability is not partisan. It is foundational.

Structural commitments already exist in health care. Certificate-of-Need regulations bind hospitals to long-term service obligations. Medicare Advantage plans face multi-year barriers to expansion if they abandon counties. These mechanisms exist because predictability matters — to patients, to communities and to the health care workforce. Maine can adopt a similarly narrow, targeted statute requiring commercial insurers to honor long-term commitments to the people they serve.

A 20-year reentry ban would end the practice of insurers using the threat of departure as leverage. It would force transparency. It would give regulators firmer ground during negotiations. And most importantly, it would allow families to make health care decisions without fearing the rug will be pulled out from under them.

Critics worry such a rule could reduce competition. But competition disappears the moment an insurer exits. The damage is already done. A reentry ban does not harm competition; it protects it by keeping insurers engaged rather than letting them destabilize the marketplace.

Others warn insurers might leave the entire state to avoid the risk. But no insurer abandons profitable markets. They will not leave Portland or southern Maine because negotiations in Bangor are tense. Maine’s population is too engaged in health care for that scenario to be realistic.

Still others argue this rule could give hospitals too much leverage. But stability is not a gift to hospitals. It is a safeguard for patients. And Maine can pair a reentry ban with strict oversight — public rate review, network adequacy standards and transparent reporting — to ensure accountability across the board.

Instability doesn’t only appear when insurers threaten to leave major systems. It shows up in quieter ways — especially for older adults. Across the country, insurers are reducing payments to brokers who help seniors navigate Medicare Advantage plans. Brokers are often the only guides many older adults trust. Cutting them out is not about efficiency. It is about cost avoidance. And in the oldest state in the nation, weakening this support is more than a bureaucratic shift — it is a genuine threat to informed decision-making.

Rural Maine feels this fragility most. Nearly half of our rural hospitals operate at a loss. Many are precariously close to cutting essential services. When insurers pull away from rural regions, they are not leaving behind spreadsheets. They are leaving behind neighbors, veterans, grandparents and towns that have kept this state alive for generations.

When insurers decide that seniors or rural communities are “too expensive,” something fundamental has gone wrong. These are the people who staffed our mills, worked our boats, tended our forests, raised our families and held this state together. They deserve reliability — not retreat.

The hopeful truth is this: we can fix this, and we can fix it together.

Maine has a deep history of bipartisan governance. Republicans value accountability and predictability. Democrats value access and fairness. Independents demand practical solutions that work. A 20-year reentry ban reflects all three. It ensures insurers act with discipline, protects patients from sudden shocks and prevents chaos.

Maine has weathered hard challenges before — economic downturns, storms, labor shortages and health care crises. Our hospitals continue to push through extraordinary strain. Our health care workers show up every day, even when the system frays. 

Now insurers must show the same commitment. If they cannot be steady partners, they should not be here.

A 20-year reentry ban will not solve every problem, but it will give Maine something precious: solid ground. It will tell families their care will not disappear overnight. It will tell hospitals their partners cannot abandon them. And it will tell insurers that Maine expects — and deserves — the same loyalty our health care workers demonstrate every day.

We can build a system where insurers stay because staying is the right thing to do. Where older adults receive the guidance they need. Where patients do not fear sudden disruption. Where stability — not volatility — defines health care.

The foundation of Maine’s health care system has begun to shift. But we can shore it up now — before the structure gives way.

Maine deserves a system as steadfast as its people.