Douglas R. Robbins, MD, is a clinical professor of psychiatry at Tufts University School of Medicine and a member of the Maine Council of Child and Adolescent Psychiatry and
Maine chapter of the American Academy of Pediatrics.

Affordability and access to health care is already a serious problem, and for some an impossibility — in Maine, and across the U.S. Many pay high premiums for health insurance with such high deductibles that they are, in fact, uninsured except for catastrophic illness.

As reported in the Portland Press Herald by Joe Lawlor on Sunday, March 29, people with Affordable Care Act insurance, whose premiums have skyrocketed in Maine by 77%, have decided to risk going without insurance. This adds to the injury of $4/gallon gas, continuing high prices for housing, food and other necessities and deep concerns about the future of the United States.

Millions in the U.S. and thousands in Maine will lose health insurance after the midterm elections, when the drastic cuts to Medicaid and to health services, programs and grants take effect. The Republican “One Big Beautiful Bill Act” will cut nearly $1 trillion from Medicaid (MaineCare). The cuts will affect rural states, such as Maine, disproportionately.

Medicaid is necessary and lifesaving not only for those directly insured, but also for those with commercial health insurance, because the costs of care for the uninsured add to the costs for all. The rationale for the cuts to Medicaid, the Supplemental Nutrition Assistance Program (SNAP) and the Women Infants and Children (WIC) program has been that they are needed to offset the cost of the cuts to taxes for the wealthy — part of the long-discredited “trickle-down” idea that enriching the rich improves our economy as a whole.

Now, we hear talk of possible further cuts to Medicaid and other basic functions to offset a record-breaking $1.5 trillion funding request for the military in 2027. President Trump said on April 2 that “We’re fighting wars…, the states can pay for daycare, Medicaid, Medicare and all these little things, all these little scams …. education belongs to the states…”

Many are looking at whether and how Maine and other states can, indeed, cover the loss of federal funds for health care. One suggested possibility to cover the losses is by cutting other spending; the largest spending target for states to cut is K-12 education.

State taxes could be raised, but Maine already has a relatively high rate of income tax. States could disenroll many of those now on Medicaid — who would then be uninsured. Gov. Mikie Sherrill of New Jersey has proposed a plan to fine companies that have large numbers of employees on Medicaid, rather than providing employer-paid health insurance.

Since even before the debates over Obamacare, we’ve waited for the Republicans to present an alternative to fix our health insurance problem, and we’ve heard primarily of increasing health savings accounts, which are never a sufficient way to insure for serious illnesses or injuries. None of these options is a realistic possibility for replacing the health care funding that is being cut. The possibility that new cuts will go even deeper to pay for a “War of Choice,” as well as for tax cuts that mostly benefit the wealthy, is outrageous.

We must be aware that this goes far beyond affordability and money, to our fundamental values and responsibility to one another. We know that when people do not have health insurance, many of our neighbors and family members will become more severely ill, more disabled, will need more care, and that more will die of preventable illness.

Treatment for mental illness in the young is already a statewide and national emergency, and the coming cuts will hurt many — long into the future. Because of our concerns, a group of pediatricians and child and adolescent psychiatrists has started the Access Initiative, a project to monitor data that reflect problems with access to needed services by children, adolescents, young adults and their families.

With support by a grant from the Maine Health Access Foundation, we are tracking data on the number of those whose mental health or substance abuse needs result in trips to hospital emergency departments, who become involved with police, who enter foster care, the number who are chronically absent from school due to mental illness and who wait weeks and months for home-based treatment to avoid longer hospitalization, residential treatment and juvenile justice incarceration.

We know that when mental illness is treated in its early stages, young people can grow and thrive, despite challenges. Evidence-based, cost-effective treatment can prevent mental illnesses and substance abuse from becoming crippling, with tragic effects on individuals and on their families.

We began in January to report these observations regularly, to help the public, health care leaders, government and political leaders, educators and others. Our goal is to increase awareness so that we can work to minimize the damage to young people and our future.

Mainers need to be aware of these realities and to let our elected representatives, in Augusta and in Washington, D.C., know that we are watching, and that we need them to support our country’s medical and other safety nets. We also need to demand commitments, beyond just expression of “concerns,” that they will vote to improve, not to dismantle, our health care.