Charles Danielson, MD, MPH, FAAP, lives in Wayne.
At a personal level, all of us have a sense of what it is like to be abandoned. As we scale it up, it now applies to the approach to many of our challenges and problems. Our rural hospitals, and especially birthing centers, are severely threatened.
We are all aware of the ax being thrown at rural communities by the looming federal cuts to Medicaid. For rural communities these cuts are not only hitting “underserving” Medicaid patients, but it is hitting all of us.
Overall, MaineCare (our version of Medicaid) covers over 4,000 births per year, or 37% of the births in 2022. In the rural poorer counties, MaineCare insured births at a 60% rate in Washington County, a 58% rate in Piscataquis County and a 51% rate in Somerset County.
MaineCare is infrastructure for birth-related services. It affects our whole community. In my pediatric practicing days when I was called to a problem delivery, the resources and salaries of the nurse were, to a great extent, paid by Medicaid.
In a rural community there is no economy of scale in a delivery room. If you destroy the infrastructure then an understaffed and undertrained unit is what you get whether you have no insurance, MaineCare or private insurance.
Take away these infrastructure dollars and, just like roads and bridges, the road into life for new Mainers will be rough and at times tragic when things collapse. We are in this together. Rural Maine and rural America have health care challenges, but cutting Medicaid is abandonment.
The “move fast and break things” mantra may be acceptable when you are looking at market share for some innovation that we have forever lived without. When it is applied to real world situations that lead to a mother delivering on the back seat of a car in a snowstorm it is immoral. Yet it aligns with the abandonment world view. Abandonment is intentional. It goes beyond simple blinders.
A sneaky and pernicious feature is the abandonment of certain data collection, often under the guise of reducing red tape. So rather than recognizing the bumpy highway before the collapse, we have hand wringing and victim blaming after. The Pregnancy Risk Assessment Monitoring System, or PRAMS, is being cut at the federal level.
Aside from lip service by federal leaders, real innovation at the community level has been abandoned. They have not articulated a vision of progress. A big tent view of the birthing community goes beyond the local practitioners, hospitals, referral centers and insurers. It embraces young families and their community-specific needs.
Innovation implies creativity and the flexibility to leverage traditional resources including WIC, private insurers, MaineCare and other state programs to complement community-specific resources (such as employers, unions, local government, not-for-profits, Native American tribes) to address the community needs.
From a health service perspective, the core components and functions of the birthing system are known. The communities can be supported in efforts to smooth the road and fix the bridges in their system. This is not rocket science. It is people coming together around a time for celebration.
Abandonment maybe a dirty word, but it is a worse policy.