Over 20 Downeast healthcare organization leaders and providers met with U.S. Senator Angus King at Eastport Health Care (EHC) on the morning of July 5 to voice their concerns about the Senate's proposed legislation that would replace the Affordable Care Act (ACA). With many of the providers involved with Federally Qualified Health Centers (FQHC) in the county, King was particularly interested in what they had to say. "If it weren't for FQHCs in Maine, we'd be sunk," he told them. FQHC organizations qualify for enhanced reimbursement of Medicaid and Medicare funds and provide service regardless of ability to pay.
     At the invitation of EHC CEO Holly Gartmayer‑DeYoung, participants gathered in a circle to share their stories and fears. One organizational leader shared that, when the ACA enrollment period started, 300 signed up in the first month who had never had health insurance before. Of those 300, four were diagnosed with cancer. The same kinds of stories filtered through during the morning. King nodded and told his own story of when as a young man he worked for a senator, received health insurance and had a free annual check‑up, the first in about seven years. A melanoma was caught. If not for that free annual check‑up included in his insurance, he "would not be here today," he said. King expanded the theme to all the young men like himself who were not the beneficiary of such services and who may well have died since.
     King characterized the Senate's legislation, the Better Care Reconciliation Act (BCRA), as "terrible." He said, "It's a tax cut and a Medicaid cut, not a healthcare bill." The legislation is expected to be taken up by the Senate during the month of July, and King stated that if the bill passes in the Senate, the House would pass it the next day. Just a few Senate votes are needed to tip the balance against the BCRA passing, he explained. "If it gets passed as is, we're done." Pausing, he added, "For the life of me I don't understand why they [BCRA proponents] don't want people to have health insurance."
     During his walk in the Eastport Fourth of July parade King heard from numerous people. "I have never marched in a parade where peopled talked policy." He explained, "Yesterday a noticeable number of people said, 'Save my healthcare,' all along the route."
     Talking with the providers at EHC, King told of conversations he has had with a few conservative senators about their reasons for supporting legislation like the BCRA. One, a fellow Christian, felt that the responsibility for healthcare should belong to family and state. Both, King felt, could not possibly deal effectively with the changes and costs that have taken place in the healthcare field. He noted that cancer treatments easily exceed $200,000, not an amount most families could come close to managing. And "states will have to make choices," he said, if given a set sum of money to spend on residents' healthcare, especially in a state like Maine with an older population. He characterized two other senators he spoke to as intellectually honest with the chilling words that if a person does not have health insurance and becomes ill "then they die."
     In a prepared statement issued later in the day, the senator stated, "I have long been concerned about what this bill will do to folks across Washington County and throughout Maine. I am very concerned that people in communities like Eastport and Machias will get hammered by this bill C that it will make health insurance more expensive for them, that it will put it out of reach for others and that it will endanger community hospitals in rural parts of the state." He added, "These were also the same concerns I heard today from healthcare providers, and it has only reinvigorated my determination to stand up for Maine people and fight against this terrible bill. People across the state deserve affordable, accessible and high‑quality health coverage, and that's not what this bill gives them."
     King also visited with providers at Down East Community Hospital in Machias in the early afternoon of July 5.
Comparing the ACA and BCRA
      King referenced Kaiser Family Foundation information that compares the ACA and BCRA with a number of different scenarios for those currently enrolled in the ACA marketplace. Estimates are according to age, income and location so that citizens will understand the potential impact of changes to health insurance. According to the estimates, Washington County residents enrolled in the ACA would see some significant changes to their costs.
     A 40‑year-old earning $30,000 would see the ACA silver plan cost of $7,390 remain the same under the BCRA. The tax subsidy would decrease from the ACA's $4,910 to the BCRA's $3,490. Premium costs after credits would be $1,060 under the ACA and $3,490 under the BCRA. A 40‑year-old earning $50,000 would receive $2,290 in ACA tax credits and zero tax credit under the BCRA to offset the $7,390 in silver plan premiums.
    A 50‑year-old earning $30,000 would see the ACA silver plan cost of $15,700 jump to $21,010 under the BCRA. The ACA tax credit of $13,210 would increase slightly to the BCRA credit of $13,910. The premium cost would increase from $2,490 to $7,170. A 50‑year-old earning $50,000 would see the ACA silver plan cost of $15,700 increase under the BCRA to $21,090. The ACA tax credit of $10,066 would decrease to zero under the BCRA. Premiums would jump from $5,100 to $21,090 per year.

'A cruel piece of legislation'
     The BCRA legislation calls for changes to Medicaid, which would not only affect those enrolled but also the viability of community hospitals and clinics in rural Maine. EHC CEO Gartmayer‑DeYoung noted that Medicaid dollars are dollars invested well. If changes come to Medicaid and the ACA, she anticipates closures and cutbacks in healthcare organizations. King pointed out that 70% of nursing home residents in Maine are enrolled in Medicaid. During a town hall meeting with King sponsored by AARP, there were over 10,000 people on the phone lines. "It was the most they'd ever had," King said, "and all the calls were about their worries."
     Senator King has spoken out against the American Health Care Act, which is the House‑passed healthcare bill, and the Senate healthcare bill as "the most ill‑conceived, damaging and downright cruel piece of legislation" he has seen in his adult life. He has blasted the bill's "age tax," which makes insurance more expensive for older Americans, and denounced the bill's impact on Maine's fight against the opioid epidemic, its impact on people with disabilities and how it will harm rural hospitals across the state. King opposes the repeal of the ACA and has repeatedly called on his colleagues to engage in bipartisan discussions to make meaningful improvements to the law before rushing to repeal it.