Opinion: Promoting health equity by preserving Maine’s health care safety net

Family doctor examining throat of a small black boy while visiting him at home during coronavirus pandemic.

MaineCare reimbursement rates for Federally Qualified Health Centers (FQHCs) serving Mainers living in poverty have not been updated in over 20 years, directly impacting access to essential healthcare to one in six Mainers. And as the nation continues to debate access to affordable healthcare for all, real-life health disparities within Maine communities continue to grow.

According to the 2020 census, nine percent of Maine’s residents, roughly 125,000 people, identify as Black, Indigenous or People of Color. These Mainers typically experience unemployment and poverty at twice the rate of white Mainers. And African-Americans experience death from heart disease, cancer, and diabetes at rates 30-40 percent higher than their white counterparts.

COVID-19 impacted all Mainers, but not equally, due to the social and structural drivers of health inequity. At the height of the pandemic, Maine had the nation’s largest racial disparities in COVID cases – a rate 20 times higher than white people. One in every 27 Black Mainers tested positive for COVID compared to one in every 725 white Maine residents.

These disparities were addressed during the civil rights movement of the 1960s with the bi-partisan creation of “Neighborhood Health Centers,” a federal effort to fund public and private non-profit healthcare organizations in medically underserved communities, to improve the lives of people living in poverty.

This is where Federally Qualified Health Centers take center stage. Originally known as Neighborhood Health Centers, FQHCs were emblematic of the civil rights movement seeking to improve the lives of all individuals living in poverty. By combining the resources of local communities with limited federal support, FQHCs provide compelling proof that affordable and accessible health care produces compounding benefits. It is also worth noting that FQHCs are Maine’s health care safety net and make up the largest independent primary care network in the state, providing an array of services to individuals regardless of their ability to pay, improving health outcomes, and supporting communities to achieve their fullest potential.

In other words, life is better for everyone if we’re all healthy.

April is National Minority Health Month, a time to highlight the importance of addressing healthcare disparities and achieving optimal health and wellness for all people who are disadvantaged by their race, ethnicity, gender, sexual orientation, social and economic status, or geographic location.

Because MaineCare reimbursement rates for Maine FQHCs are outdated and don’t reflect current total cost of care (the average current gap across FQHCs between the MaineCare payment rate and the cost of care is 60%), these services are now in jeopardy.

LD 1787, “An Act To Improve the Quality and Affordability of Primary Health Care by Stabilizing Funding”, addresses these concerns and parallels rebasing that was provided to another type of primary care provider that is paid on a similar federal model. In 2019, outdated rates for “rural health clinics” were rebased in the same way that LD 1787 would rebase FQHCs. Unless the reimbursement rates are updated, payments to FQHCs will continue to be reduced, impacting our many vulnerable populations for generations to come.

National Minority Health Month can serve as a time for us to reflect on our ability to access healthcare and advocate for the health care of all. Passing LD 1787 is a good start.

Photo: Drazen Zigic, Getty Images

About Arabella Perez and Regina Phillips

Avatar photoDr. Perez is a licensed clinical social worker and therapist of 30 years. She holds a Master's and a Doctorate Degree in Social Work from Tulane University in New Orleans. She is a native Spanish speaker and the daughter of parents from Cuba and Puerto Rico. Regina Phillips, MSW is an adjunct professor at the University of Southern Maine School of Social Work. She received her undergrad from Curry College in Milton, MA, and her Master of Social Work from UNE. She is currently getting her Doctor of Social Work at Tulane University.

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