For my patients, cost is the most common barrier to care. This year, costs are going up – again – for hundreds of prescription drugs. Insurance premiums continue to increase. A recent report brings more bad news for Mainers who are already struggling with big medical bills: Maine hospital prices exceed the national average by nearly 25%.
Maine now has the regrettable distinction of having the highest cost of care in New England. As a physician, I know this isn’t a record we should be proud of. Thankfully, policymakers are taking steps to address rising costs and have opportunities right now to help bring down high hospital bills and help reduce medical debt for patients like mine.
Lawmakers can pass L.D. 2271, which would help provide transparency around “facility fees,” charges that hospitals tack onto bills without prior notification to patients. Even though a clinic or office where a patient gets care may be nowhere close to the hospital, they can get these fees tacked onto their bills if the provider is affiliated with a hospital system – as many are. According to analysis by the Health Care Cost Institute, the additional costs can be significant: When hospitals bill a facility fee, the price for an ultrasound increases from $164 to $339, the price for a biopsy increases from $146 to $791, and the price for an office visit increases from $118 to $186. In Maine, a hip replacement surgery costs $44,850 – two and a half times the cost in Boston, where hip surgeries are $16,150.
L.D. 2271 would help provide much-needed transparency, requiring hospitals to post notifications that a facility fee will be charged. This is particularly poignant where I practice, which is essentially equidistant from two hospitals and just a short drive down the interstate to a third. The proposed legislation is the result of recommendations made by the Task Force to Evaluate the Impact of Facility Fees on Patients, created by a bill sponsored by Senate President Troy Jackson last legislative session.
This bill is an important first step to help lower health care costs and reduce medical debt by helping Mainers better understand the cost of their medical care so they can make informed decisions. But more also should be done to help patients who are already dealing with medical debt from health care they have received.
As patients rack up more and more medical debt, they may become even less inclined to seek care. I’ve cared for patients who ration care to avoid more medical bills, only to see an otherwise manageable chronic condition – diabetes, arthritis, heart diseases – get worse and put their lives at risk. Cancer patients should be able to focus on getting well, not worry about whether their infusion is going to cost more because of where the procedure is done.
That’s why lawmakers should also work to pass L.D. 1955 to help address the medical debt crisis in our state. The bill, sponsored by House Speaker Rachel Talbot Ross, recently received a majority vote in favor by the Health and Human Services Committee. It would increase eligibility for Maine’s Hospital Free Care program for people with income up to 200% of the federal poverty level. Because Maine hospitals are tax exempt, federal and state law require hospitals to provide ”community benefits,” including Free Care. As health coverage has become more available and Maine’s uninsured rate has decreased, the amount of Free Care provided by Maine hospitals has decreased by millions of dollars over the years. The bill would make the program more accessible by requiring hospitals to widely publicize their programs and reduce red tape in the application process.
Maine policymakers can act not just to reduce medical debt but to prevent it from accumulating in the first place by reining in unfair facility fees. Maine’s Legislature created the task force to study facility fees, and now it’s time for lawmakers to do more and put some of its recommendations in place to lower costs for my patients.
By holding Maine’s out-of-control hospital fees in check and addressing medical debt for patients who already have it, we can provide real relief to families already struggling with huge medical bills, and help encourage them to seek care when they need it – not just when they can afford it.
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