Amid rising costs, lawmaker wants to restart conversation about universal health care
Mainers spend more than $18.5 billion annually on health care, nearly 20% of the state's Gross Domestic Product, according to a 2024 report from the Maine Center for Economic Policy. (Photo:)
One legislator is pushing to explore the possibility of a publicly funded universal health care system for Maine, which would expand coverage to more than 59,000 currently uninsured residents.
During a public hearing on Wednesday, proponents stressed the urgent need for a better health care system, though the state's affordable health care office said there is 'no path forward' for establishing such a program right now.
One bill, LD 1269, proposes a comprehensive study to analyze the costs and feasibility of a universal health care plan. Another, LD 1883, offers a detailed blueprint for a state-wide system called the All Maine Health Program that would provide comprehensive coverage to all Maine residents.
If passed, Maine would be the only state in the country to shift to a universal health care system.
During the hearing before the Health Coverage, Insurance and Financial Services Committee, Rep. AnnMarie Mastraccio (D-Sanford), who introduced both bills, said a state-wide system has not been studied comprehensively since 2002, and that 'it's time to update those numbers and evaluate our options.'
She is aiming to address rising health care challenges including the closure of hospitals in rural Maine, the uncertainty around Medicaid funding, and overall health care costs increasing. Mainers spend more than $18.5 billion annually on health care, nearly 20% of the state's Gross Domestic Product, she said.
'Maine's current health care system is fragmented, inefficient and economically unsustainable,' Mastraccio said.'As legislators, we have a responsibility to make data-driven decisions that promote a sustainable, equitable health care infrastructure that begins with understanding the true costs and potential savings of a universal, publicly funded system.'
Dozens of health care providers, advocates and Mainers who have struggled with medical costs testified in support of the bills, highlighting the urgent need for reform. They pointed to the lack of access to providers in rural areas, racial disparities in health care access in the state and the financial strain on both patients and providers because of the patchwork system of insurance coverage.
'The burden of this poor health infrastructure falls disproportionately on women of color, Black and Indigenous women and low income and rurally located women,' said Lily James, advocacy coordinator for the Maine Women's Lobby.
For example, 65% of pregnant Black Mainers receive adequate prenatal care in 2022, compared to 87% of white Mainers, according to Maine Department of Health and Human Services data. And 22% of pregnant Mainers have to travel more than 45 minutes to access a birthing hospital, according to a 2023 report that James cited.
'The All Maine Health Program would be life changing, and in many cases, life saving for so many Mainers and will pave the way for the desperately needed changes to Maine's health care infrastructure,' James said.
A November 2024 report from the Maine Center for Economic Policy found that, based on current demographics and insurance coverage, the cost of such a program would roughly equal the amount Mainers spend now, between $17.8 and $19.3 billion.
Testifying on behalf of the plan, James Myall, a policy analyst for MECEP who authored the report, said that, unlike the current system, the cost of a universal system could be offset by other revenue streams, such as federal grants or increasing taxes on the wealthiest Mainers.
'This means that most Mainers will pay less under the proposed plan than under the status quo, while also being free of the stresses that come from being unable to afford copays and deductibles, worrying about in-network coverage, or switching insurance providers,' he told lawmakers.
Meg Garratt-Reed, director of Maine's Office of Affordable Health Care, which was established by the Legislature in 2021, testified against both bills, saying the state isn't in a position to implement them with the current financial constraints and the amount of change that would be required to implement the program. While she acknowledged that Maine's health system is flawed and praised the intent behind the bills, she said a single-payer program would be too costly and complex to set up right now.
The All Maine Health Program aims to save money by removing insurance companies from the system, which would reduce administrative costs like billing as well as shareholder profits. But Garratt-Reed said those savings wouldn't be enough to offset the added expenses in the plan. The bills would expand what's covered, increase payments to providers, and do less to limit unnecessary or overly costly treatments — all of which would drive up overall spending.
She also said the bills would move away from the current cost-control system used by Medicare and MaineCare, Maine's Medicaid system, which set fixed prices for services. Instead, the state would have to negotiate rates with each provider — a more complex and less efficient process that could lead to even higher costs.
The proposal also relies on using federal money (such as Medicaid and Medicare funds) to pay for the new system — but federal law doesn't let states reallocate money designated for specific programs without special permission, she said. And the federal government is very unlikely to give that permission, Garratt-Reed said, especially under the current political situation, pointing to congressional Republicans' proposal to drastically cut Medicaid funding.
'I think we can all agree that our current health care system is flawed, and that many people suffer because of those flaws. However much we may wish that we could recreate our nation's health care system from the ground up, we have a responsibility to those people to pursue solutions that have real potential to ease their suffering,' she said.
'The reality is there is no path forward for implementing such a program in Maine now or in the immediate future.'
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