Housing is a health care issue. That was one of the main takeaways from panelists at an event hosted by The Maine Monitor and the Goldfarb Center for Public Affairs at Colby College on Wednesday evening.
“It’s housing,” said Michael Tyler, managing partner Sandy River Company and chair of the board of the Maine Health Care Association. “If people can’t afford to live here, how can we expect to increase the workforce? It is impossible.”
The housing crisis, panelists acknowledged, is a nationwide issue decades in the making, driven in part by rates of construction falling behind population growth, restrictive zoning, weaponized regulation, and rising interest rates, as well as, in Maine, an aging housing stock and a growing short-term rental and seasonal home market.
On any given day in Piscataquis County, said panelist and public health advocate Sue Mackey Andrews, half of the staff on the floor of the local hospitals are traveling providers who come for short stints.
“What do you do with travelers when they come to Maine? You find them housing. So the first thing that happened was they took all the motels… [then] a couple of hundred houses were sold, renovated into AirBNBs.”
Now, said Mackey Andrews, “We have homeless families, we have homeless people…today I dealt with a 74-year-old man with significant diabetes who is homeless, who has been homeless since October.”
A shortage of housing has also made it difficult to recruit and retain providers in rural areas, said Katherine Simmonds, clinical professor in the School of Nursing within the Bouvé College of Health Sciences at the Roux Institute.
“They might have a really terrific Ob/Gyn who they’re ready to sign, who says ‘but there’s nothing here for my wife to do.’ Or ‘we can’t find a house,’” said Simmonds. “I think until we start really coming up with innovative community-based opportunities for people to bring their whole family — it is a challenge.”
Difficulty recruiting is one of the reasons hospitals began relying on traveling providers in the first place, a trend that accelerated during the COVID-19 pandemic, said Steven Michaud, president of Maine Hospital Association. Traveling providers are also more expensive, furthering financial strain on already struggling rural hospitals.
“We settled at 50 percent more traveler costs than we did entering the pandemic, and we remain there,” said Michaud. “That is just one factor, among many, that is aggravating the financial status of Maine hospitals.”
Panelists also pointed to an aging population, aging workforce, high reliance on government-funded insurance programs (Medicare and Medicaid, known in Maine as MaineCare) and low reimbursement rates from those programs as primary drivers of the closing of nursing homes and hospital-based maternity units in recent years.
Maine — the oldest state in the nation — has lost 29 nursing homes in the past decade. “It’s not because there isn’t need,” said Tyler, of the nursing home closures. “There’s plenty of need. There just aren’t plenty of employees.”
In that same timeframe, ten hospital-based birthing units have closed or announced that they will close, including four this year, leaving half of the state’s hospitals without birthing services.
The problems facing birthing units are a “microcosm” of the wider issues in health care, said Simmonds.
Meanwhile, stalled budget negotiations in the Legislature resulted in paused MaineCare reimbursements to providers. At the federal level, Congressional Republicans have proposed $880 billion in cuts, largely to Medicaid.
“There’s no way you’re getting $800 billion out of that budget,” said Michaud, paraphrasing Sen. Susan Collins, “and not emaciating [it].”
“Medicaid drives everything,” said Dr. Scott Hanson, president of the Maine Medical Association, who was in the audience. ”It’s the floor.”
Hanson also called prior authorization requirements by insurance companies, in which providers must obtain approval from a patient’s health plan before providing services, a “scam” that is behind many of the problems.
“Delay, deny, defend,” said Hanson, referencing the phrase inscribed on the ammunition used in the shooting of UnitedHealthcare CEO Brian Thompson. “That was a terrible tragedy, but it’s true the money that is being sucked up into profiteering and shareholders benefits by United and Anthem and Cigna and Aetna and all the rest of them.”
“We can start,” Hanson continued, “by banning prior authorization so that hospitals get paid for doing the work that they need to do instead of just generating profits for insurance companies.”
Simmonds pointed to a few bright spots in maternity care, including work being done at the Roux Institute and at the state level to check on patients throughout a pregnancy, particularly in rural areas, to ensure they show up at delivery as healthy as possible. There are also proposals to financially reward providers who help keep patients healthy throughout pregnancy, said Simmonds, rather than the current fee-for-service model.
Asked what they would change if they could alter one aspect of health care in the United States overnight, Simmonds pointed to reimbursement and an acknowledgement that “everyone deserves health care.”
Mackey Andrews said the future was in funding community health workers tasked with visiting patients in their homes and providing basic care. “People who see patients in their office don’t know what the living room and the kitchen and the bathroom look like,” she said. “Somebody needs to know with eyes on what the safety issues are. Do they have running water? Do they have plumbing? Do they have electricity? Do they have a place to sleep?”
“We’re not going to grow a lot more doctors and nurses overnight,” Mackey Andrews continued, “but we could grow more [community health workers].”
Michaud said he would “dramatically increase” investment in primary care. “That whole area of the healthcare system is rapidly decaying for one thing, and it has huge implications for people.”
Tyler said he would address the housing crisis and echoed Simmonds’ comment on everyone deserving health care.
“These are essential services. They’re not optional.”
