Policy experts have warned that Mainers are facing a cliff in affordable, accessible health care. About 31,000 Maine residents could lose MaineCare coverage as the result of federal cuts to Medicaid, while some 78,000 could be subject to new work requirements. Residents of Maine’s most rural counties could be hit hardest by these cuts.

Parts of the state are already facing diminishing services: Maine has the second-highest rate of maternity unit closures since 2020 in the country. The scheduled closure this December of MaineHealth Lincoln Hospital’s labor and delivery unit in Damariscotta will mark the 12th such closure since 2015.

The Maine Medical Association, which represents doctors, has called for significant reforms to the U.S. health care system, saying that it fails patients and physicians in multiple ways: Health care is too expensive; inequities in access fall largely on marginalized groups; and doctors are overburdened with paperwork that takes away from patient care. The association supports federally backed universal health insurance coverage but, acknowledging that it is unlikely in the near term, called on Maine officials to work toward statewide universal health insurance coverage.

Ahead of next month’s election, The Maine Monitor reviewed the three gubernatorial candidates’ health care policy proposals. All three –– independent Rick Bennett, Republican Bobby Charles and Democrat Hannah Pingree –– called for increased Medicaid reimbursements for providers, intensifying efforts to recruit new providers to the state and incentivizing established providers to remain. Bennett and Pingree aligned on several points, including working toward universal health insurance coverage, while Charles has opposed Medicaid expansion and was an outlier on issues such as abortion, addiction response and alleged Medicaid fraud.

Here’s a look at what the candidates have said about how they would tackle the most pressing issues in health care.

Rick Bennett

Maine should have an “affordable, accessible and stable” health care system, according to Bennett’s four-point health care policy proposal. He believes Maine can stop hemorrhaging rural health care services in part by increasing MaineCare reimbursements, investing in primary and preventative care, and through medical debt relief and universal health care.

“It’s very grim what’s happening in rural Maine in particular, but across the whole health care system,” Bennett told The Monitor in a September interview. “We’re losing scores of providers.”

Bennett claimed that public trust in MaineCare, the state’s Medicaid program, has diminished due to what he sees as mismanagement and a lack of transparency and accountability. MaineCare reimbursements for covered services do not adequately cover facilities’ costs to provide those services, nor does the state provide reimbursements in a timely manner, he said, which has led several providers to close.

“The very first thing I’ll do is pay our providers fairly and on time,” he said.

The independent, who until last year was a registered Republican, said that Maine operates on an “upside-down system” that spends more money on emergency and crisis services than on primary and preventative care.

He suggested that Maine could do more to build and retain its health care workforce through programs such as making Doctors for Maine’s Future, a scholarship program for students enrolled in eligible Maine-based medical school programs, a permanent allocation in the state budget.

Bennett said as governor he would launch a medical debt relief program, starting with an initial $2 million investment and a partnership with a national nonprofit organization that specializes in medical debt relief. He also said Maine’s abortion laws are working well, and he supports “the right of every woman to choose the kind of health care and reproductive care that she wishes.”

Among those who have endorsed Bennett are Rep. Lydia Crafts, a Democrat who formerly served on the Maine Recovery Council; Augusta city councilor and Maine Recovery Access Project Executive Director Courtney Gary-Allen; and the Brett M. Staples Brain Disorder Awareness Coalition.

Bobby Charles

Charles, the Republican nominee for governor, has focused primarily on what he claims is rampant fraud and mismanagement within the Maine Department of Health and Human Services, which accounts for nearly half of the state’s budget and oversees child welfare, disease prevention, public assistance and more.

Unlike the other two candidates for governor, Charles has not published a detailed health care policy plan. But at the top of his 20-point plan to “restore transparency and protect Maine taxpayers,” Charles said as governor he would fire all Department of Health and Human Services leaders, mid-level program managers deemed “ideological” and others involved in “corrupt contracting.”

He would also plan to slash the Department of Health and Human Services’ budget in half.

“The government has really, fundamentally, in my view, mismanaged health care in this state,” Charles told The Monitor. “The bills have not been paid on time. The reimbursement levels are not where they belong in order to keep a hospital moving forward.”

Charles said Maine needs to do a better job getting health care professionals to come to Maine by making it an attractive and affordable place to live, particularly for families. Reducing housing costs and taxes, improving schools and increasing medical residency opportunities are among the ways to do this, Charles told The Monitor.

Charles also has strong views about how the state can address substance use. He believes the state needs to do more to crack down on the illicit drug supply and end harm reduction programs in the state. Rather than focus on the distribution of sterile syringes, he said the state should ensure every person who has an overdose reversed by naloxone is immediately sent to a seven-day detoxification program, followed by a 60- to 90-day residential treatment program.

Charles often points to his time leading the U.S. State Department’s Bureau of International Narcotics and Law Enforcement Affairs under President George W. Bush as part of his crime-fighting resume. Federal auditors found the bureau under Charles’ leadership was mired in poor management.

Charles told NEWS CENTER Maine earlier this year that abortion is “abhorrent.” In an interview with the Christian Civic League in June, he said he could convince any pregnant woman to not have an abortion.

Vice President JD Vance campaigned with Charles in Brewer in September. Former House speaker Newt Gingrich and the National Rifle Association have both endorsed Charles.

Hannah Pingree

Pingree, the Democratic nominee, has a three-pronged health care plan that focuses on establishing a public health insurance option, expanding and maintaining health care access particularly in rural areas, and strengthening the “basic needs that form the foundation of healthy lives,” such as housing and food security.

Pingree said her work as director of the Governor’s Office for Policy Innovation and the Future and the eight years she spent in the state Legislature make her well-suited to tackle these issues.

The office, which was established during Gov. Janet Mills’ first term, serves as the policy hub for the administration’s initiatives on opioid response, aging, housing development and more. Pingree served as director for six years, leaving last year before launching her gubernatorial campaign. In the Legislature, she was chair of the health and human services committee and served as speaker of the House for two years.

Maine needs a public health insurance option in which the state would negotiate with insurance providers for better rates, Pingree said. This option would not replace Medicaid or private or employer-provided insurance. Maine is facing a health care crisis, she told The Monitor, as the result of federal cuts to Medicare and Medicaid. Meanwhile, health care services in rural areas are diminishing, particularly when it comes to maternity and primary care.

Pingree spoke out against the closure of the maternity unit at Lincoln Hospital earlier this year. She also said that reproductive rights, including abortion access, should be enshrined in the state Constitution.

Maine needs to “incentivize primary care,” she said, which it can do by increasing Medicaid reimbursement rates and recruiting more primary care providers to the state.

It’s also about making Maine a place where people want to settle down and raise their families, she said. 

“We’re the oldest state in the country. We desperately need families,” she said. “Whether it’s ensuring that you can have a baby in certain counties in Maine or ensuring that you can access child care, we need a greater focus on ensuring that families feel comfortable and safe making a life here in the state of Maine.”

Pingree has received endorsements from a number of health care and public safety organizations, including Planned Parenthood, Giffords PAC, Maine Gun Safety Coalition and Reproductive Freedom For All. She has also received endorsements from Mills, U.S. Sen. Angus King, the current and two former Maine Department of Health and Human Services commissioners, and the director of the Maine Center for Disease Control and Prevention.

Reporter Matt Junker contributed reporting by interviewing the candidates.

This story was originally published by The Maine Monitor, a nonprofit civic news organization. To get regular coverage from The Monitor, sign up for a free Monitor newsletter here.