How Trump’s cuts are reshaping America’s health system
Republicans last year cut $1 trillion from expected Medicaid funding over the next decade and let tens of billions of dollars in annual insurance subsidies expire, putting U.S. health care on a new path. While the full effects will take years to show, providers in rural states — where the cuts are projected to land hardest — are already racing to adapt. Maine has the nation's highest proportion of rural residents, an above-average share of Medicare and Medicaid beneficiaries, and the oldest average population, making it a window into the coming upheaval.
In dozens of interviews from Louisiana to Maine to Washington, D.C., providers described the changes and difficult choices they're making. Northern Light Health, one of Maine's large systems, plans to move care away from its highest-cost facilities to smaller facilities or telehealth where appropriate, build up staffing and systems to help patients navigate Medicaid paperwork, and plot savings to counter expected increases in uncompensated care and demand as other systems pull back or fail. Leaders say consolidations or closures may be needed, and other systems across the state are similarly remaking their models.
"We will look different moving forward," said Lisa Harvey-McPherson, Northern Light's vice president of government relations. "Some services that we provide today will either look different or won't be offered." She predicted a "pattern of service closures," warning that "we have a pretty fragile, unstable base upon which all of this negative activity will occur." Randy Clark, a senior vice president who leads three Northern Light hospitals, noted that financial headwinds are nothing new: "There are so many headwinds that we've had to overcome, it's hard to distinguish one from the other." Trampas Hutches, president of the Mountain Region for MaineHealth, called Maine a "canary in the coal mine" for the country, saying the things it is experiencing today foreshadow what's ahead for the rest of the nation.