“A lot of these provisions in the bill are less significant when you look at the details of how they are designed,” Pope said. The bill contains loopholes that would permit states to evade many of its so-called requirements, he said.

“My general take on this bill is that it’s trying to create the appearance of savings. The actual savings are pretty minimal. It’s carefully crafted to not do too much,” Pope said.

Jeff Austin, vice president of government affairs for the Maine Hospital Association, said the proposals that could have the most detrimental impacts on hospitals have so far been avoided, but “there are still reasons to be concerned.”

The bill introduced in Congress would fund much of the federal government, but most cutbacks in the bill are aimed at Medicaid.

The Maine Center for Economic Policy estimates that 34,000 Maine people who are currently enrolled in Medicaid would lose health insurance coverage and be in danger of going uninsured. Many would be eligible for insurance under the Affordable Care Act, but Congress is also considering reducing subsidies that help people afford ACA premiums, which could push coverage out of reach for more people.

About 400,000 Maine people are currently enrolled in Medicaid. The number of enrollees grew in recent years, partly because of the pandemic, and the Mills administration and lawmakers are debating proposals to shrink enrollment.

Along with reducing eligibility, the federal proposal could substantially increase Maine’s costs.

The Maine Center for Economic Policy is projecting a $90 million annual reduction in federal Medicaid funding per year, assuming Maine continues to allow children of immigrants and pregnant women who are immigrants to enroll in MaineCare.

Maine is one of 14 states that allow children of immigrants and pregnant immigrants to enroll in Medicaid.

“This seems to be less intended to generate substantial fiscal savings. Instead, it’s putting pressure on states to change their immigration policies,” Pope said.

HEALTH CARE PROVIDERS WORRIED ABOUT IMPACTS

As Congress considers changes to the bill, Maine health care providers said they are worried about any cutbacks to Medicaid, given an already financially strained health care system.

Even at current funding levels, Maine is struggling with its Medicaid budget. Maine needs to plug a $118 million funding hole in the current fiscal year, and has had to reduce MaineCare payments to hospitals and other providers to keep the budget balanced. At the same time, the Mills administration and some lawmakers are fighting over cost-of-living increases to direct care workers who are already in short supply.

The financial strain is only adding to a crisis in health care access in Maine, with long waits for primary care services and specialty care.

Adam Bloom-Paicopolos, executive director of the Alliance for Addiction and Mental Health Services, Maine, which advocates for nonprofit agencies, said MaineCare patients are waiting eight to 10 months for mental health and substance use disorder services.

“It’s hard enough right now in the current environment,” Bloom-Paicopolos said. “There is already a crisis in access to behavioral health services.”

The access crisis is primarily caused by a workforce shortage — which advocates say is made worse by low pay for direct care workers — coupled with a surge in demand.

He said behavioral health is “tremendously reliant” on Medicaid for funding, and they are “extremely concerned” about funding proposals in Congress.

It’s a similar story for nonprofits that provide services such as group homes and residential support for those with intellectual and developmental disabilities.

Laura Cordes, executive director of the Maine Association for Community Service Providers, said the agencies are 100% funded by Medicaid.

“We fear any cuts are going to significantly decrease community-based access,” Cordes said.

Hospitals in Maine are also in a precarious financial position, with birthing centers closing and Inland Hospital in Waterville closing in June.

Austin said if more people become uninsured, “they become more reliant on hospital charity care and financial assistance.”

“Our members currently provide almost $200 million in uncompensated care now. That amount will surely rise if implementation of these proposals results in less coverage,” Austin said.

Medicaid cuts could be compounded by other proposed cuts to the Supplemental Nutrition Assistance Program, or food stamps. The proposal, if approved, would result in a loss of $97 million in federal funding for Maine, Myall said, primarily by expanding work requirements.

If lower-income people have to spend more of their own money on groceries, that would cause a ripple effect in the economy, with people spending less of their disposable income on other items, Myall said.

The irony, Myall said, is that both Medicaid and SNAP support working adults, and imposing work requirements will result in fewer people in the workforce.

“People are going to be sicker and suffering,” Myall said. “Part of the workforce will become too sick to work, and not able to see the doctor because they’re not working.”