Jonathan Meserve, MD, is a pediatric anesthesiologist practicing in southern Maine. He lives in Falmouth.

As a pediatric anesthesiologist practicing in southern Maine, I’ve seen firsthand how fragile our health care system can be — especially in rural communities.

The passage of the “big, beautiful bill” by Congress and the subsequent government shutdown is a stark reminder of how rushed legislation can have devastating unintended consequences both nationally and especially for us here in Maine.

Do not be fooled by political spinning. Our government has shut down due to its own lack of empathy for its citizens’ health — putting short-sighted gains for the wealthy at the
expense of the middle and lower class.

Though not designed as a health care bill, the impact of the “big, beautiful bill” on the
American health care system is projected to be the most significant since the Affordable
Care Act (ACA).

According to estimates, it will undo nearly three-quarters of the coverage gains made by the ACA, stripping health care access from 17 million Americans and potentially contributing to over 51,000 additional deaths annually due to combined Medicaid cuts and loss of marketplace subsidies.

This is not alarming — it’s unconscionable.

Here in Maine, roughly 70,000 Mainers will see their ACA insurance rates dramatically increase or be lost entirely. Combine that with the estimated 31,000 who will be unenrolled from MaineCare due to Medicaid cuts, and roughly 7% of people in Maine will have a major disruption or loss of their health care coverage.

Don’t falsely assume you are insulated from these effects if you don’t rely on Medicaid
or ACA subsidies. The reality is quite the opposite.

Rural hospitals, which serve many Medicaid patients, will face severe financial shortfalls. These facilities are already struggling, and this bill could push many to closure. Uninsured patients will still arrive and receive care under EMTALA laws, but the cost of that care will be passed on to
those with insurance.

Workplace premiums will rise. Services deemed unprofitable — like maternity and preventive care — will be cut. Everyone pays more, and everyone gets less.

This will hit Maine’s rural communities hardest. A wealthy individual may absorb rising premiums with little disruption, but for middle-income families, the consequences are dire.

Consider this: a family earning $66,800 annually may receive a $750 tax cut. Yet the average annual cost of a family health insurance plan is over $25,000. That math doesn’t add up — and it’s emblematic of a broader trend: a war on our own middle class.

There are two likely outcomes from this bill:

• Hospitals close because they can’t afford to care for the uninsured.
• Hospitals survive by shifting costs to privately insured patients—on top of the
  projected 7% increase in insurance premiums year over year already occurring.

Neither scenario benefits our communities. Both disproportionately affect low- and middle-income families. And both threaten the health and stability of rural Maine far more than urban centers. Urban hospitals will become flooded with displaced patients causing wait times, frustration and medical errors.

The current government shutdown is a response to this civil attack, albeit one that further harms its own citizens. These policies and the ongoing posturing do not reflect our values. We are a state that believes in fairness and cares deeply for our communities. It is time our government started showing us it shares these values.

We can — and must — do better.