I am a primary care doctor who opposes Gov. Paul LePage’s planned reductions in MaineCare payments. There is no current deficit in the MaineCare budget, so one could conclude that he is trying to decrease the support system for MaineCare patients for ideological reasons.

In the past 20 years, primary care doctors have migrated to hospital-based practices to such an extent that only about 20 percent of primary care doctors in Maine are still in private practice. The need to standardize care and the cost of computerizing medicine were both major factors behind this change.

This movement toward larger groups allows practices to form patient-centered medical homes, which use a team approach to deliver care and, in the long run, are believed to deliver better service and be more cost-effective.

By paying facility fees, the state has made it economically possible for hospital-based physicians to see MaineCare patients. The governor’s plan, however, would stop the payment of these fees, an action that could cause some practices to close and many MaineCare patients to lose their health care. Some of them will be forced to turn to hospital emergency departments, at far greater expense for the patient and society.

Studies of health care in other developed countries have consistently shown that having a strong primary care system for patients saves substantial money. The ratio of primary care doctors to specialists in the U.S. is 1 to 2. In many European countries, there are two primary care doctors for every specialist, and care there costs a lot less.

The governor’s proposed changes will weaken the primary care system in Maine. The LePage administration seems to expect — wrongly — that MaineCare patients who can no longer be seen by hospital-based doctors will be accepted in private practices. Private-practice physicians cannot economically sustain seeing many MaineCare patients, even with the slight increase in primary care rates proposed by the governor.


The governor’s unwillingness to expand MaineCare in 2013 and 2014 denied help to the disadvantaged in Maine and cost the state a lot of federal money. About 70,000 citizens who could have had health insurance funded almost completely by federal dollars did not receive this insurance. This suggests he is not concerned with the health care of all Mainers.

Equally draconian are proposed MaineCare cuts of more than 50 percent to community-based mental health providers. Some of these agencies either will have to drastically cut services or close altogether.

If this happens, we will see the mentally ill sleeping on sidewalks as their conditions deteriorate. We also will see far longer waiting lines in emergency departments. This will cost taxpayers much more than they’d spend to adequately support the existing system.

These cuts will happen just as many mental health agencies are merging to provide better service and cut expenses and may decrease the likelihood of the success of such initiatives.

Maine is still bound by the 1990 consent decree that requires the state to establish and maintain a comprehensive mental health care system. This means a state court is likely to intervene down the road and force the administration to re-create the systems that it is about to dismantle.

My understanding is that the agreement cannot be applied proactively; instead, the judge has to wait until the damage is done. Thus, there will be a loss of institutional memory, making it more difficult to rebuild the mental health care system and more expensive to do so than supporting the existing system.


The current system for funding care to low-income Mainers is complicated, and certainly many parts of it are intricate and irrational. It does, however, generally work and takes reasonable care of most people.

The governor’s proposed drastic changes will destabilize and destroy a good part of it. I hope that Maine’s media will make a serious and thoughtful effort to explain this situation to Maine residents so that these changes can be stopped and more moderate changes can be made.

Mainers can get involved by contacting the governor and their representatives concerning support for continuing the facility fees and continuing the current level of support for community-based mental health providers.

Nancy Hasenfus, of Brunswick, is a primary care physician for a hospital-associated practice is on the board of a local behavioral health agency.

Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.

filed under: