By Julie Pease, M.D.
Maine Medicine, Jan.-Feb.-March 2015
MMA’s Public Health Committee has designated access to healthcare as one of its priorities for 2015. During 2014, access to care changed for many Mainers. On the bright side, thousands who had previously been left out of our system are now newly insured and able to access healthcare.
Regrettably, there is another side to the story. Maine is one of only two states in the country where the numbers of uninsured have actually increased – from 130,000 up to approximately 147,000 people in Maine.
And, although nearly 50,000 Mainers are enrolled in health insurance plans through the exchange, many of those individuals, plus thousands more in employer-sponsored group insurance plans are underinsured. In a low-income state like ours, with a high percentage of individuals choosing “bronze” plans and with more employers offering high-deductible plans, an estimate of 200,000 underinsured Maine people is probably conservative.
The insured or underinsured are often unable to access healthcare due to cost. They do not fill prescriptions, or they do not take them as prescribed. They delay getting necessary treatment, and the treatment they do get is marginal. This can be catastrophic. It is reliably estimated that for every 1,000 uninsured, one person will die each year due to inability to access timely medical care. We call these “excess deaths,” estimated in Maine to be between 137 and 157 deaths annually.
A survey conducted by the Maine Health Access Foundation in December 2013 showed that “a significant proportion of Maine people who were uninsured, as well as many with health insurance had difficulty paying for health care services in 2013. Those with the lowest incomes reported the hardest time affording health services, yet more than one-quarter of Mainers with health insurance (25.3%) experienced problems paying medical bills as well. Paying medical bills was a challenge for those in the lowest income group (32%), but it was also a significant problem for Mainers with middle incomes (35.4%).”
“In addition, nearly 41% (of uninsured Mainers) reported barriers to getting dental care and over one-third reported forgoing needed medical care because they couldn’t afford it.” [See more at: http://www.mehaf.org/news/2014/03/26/statewide-survey-finds-mainers-struggled-pay-health-care-costs/#sthash.N75aGHD6.dpuf ]
In countries with universal healthcare, access problems are significantly less, and healthcare costs are about half of those in Maine. With the increasing trend toward “bronze” high-deductible underinsurance, and dim prospects for Medicaid expansion, many physicians and health professionals in Maine and elsewhere are stepping up their activism for universal healthcare. Dr. Donald Berwick, former Medicare chief, garnered 21% of the Massachusetts Democratic primary vote with his single-payer platform. Despite the recent setback in Vermont’s efforts to achieve universal access, single-payer forces in Vermont are already rallying to reverse their governor’s decision to abandon this effort. A 2014 MMA poll showed that 64.3% of Maine physicians would prefer a single-payer system such as a “Medicare for all” approach. Last year, several physicians went to the Maine Legislature to testify in support of universal healthcare. Maine AllCare, a chapter of Physicians for a National Health Program, has almost 900 supporters, many of them physicians. The virtues (including universal access), the value, and the simplicity of a publicly financed single-payer approach continue to have broad popular appeal. Please join me and other MMA physicians in our advocacy for universal healthcare.
Editor’s Note: The opinions expressed above are the opinion of MMA member Julie Pease, M.D. MMA members with concurring or opposing opinions are welcome to share them with MMA for possible publication in future issues of Maine Medicine. Comments and articles (please keep your articles under 600 words) may be shared with Shirley Goggin at email@example.com.
147,000 uninsured – US Census Bureau, September 18, 2014. http://www.census.gov/newsroom/press-releases/2014/cb14-170.html
Nearly 50,000 Mainers in exchange – http://www.healthinsurance.org/maine-state-health-insurance-exchange/
Underinsured – http://www.commonwealthfund.org/publications/fund-reports/2014/mar/americas-underinsured
Excess deaths – Wilper, A. et al, Health Insurance and Mortality in US Adults, AJPH, December 2009, Vol. 99, No. 12, p 2289-2295
137 deaths – http://www.pnhp.org/excessdeaths/excess-deaths-state-by-state.pdf
157 deaths – http://healthaffairs.org/blog/2014/01/30/opting-out-of-medicaid-expansion-the-health-and-financial-impacts/
Maine Health Access Foundation Survey – http://www.mehaf.org/news/2014/03/26/statewide-survey-finds-mainers-struggled-pay-health-care-costs/#sthash.N75aGHD6.dpuf
Key Facts about the Uninsured Population – http://files.kff.org/attachment/key-facts-about-the-uninsured-population-fact-sheet
MMA Poll Question – http://www.mainemed.com/sites/default/files/content/Payment%20Reform%20 Survey%20-%20%28Crescendo%29.pdf
Dr. Donald Berwick and Single Payer – http://commonhealth.wbur.org/2014/09/single-payer-don-berwick