I feel compelled to respond to a July 9 opinion piece on the subject of hospital funding in our state (“Maine hospitals are getting a $60 million cash infusion. They must share the wealth.”). The author, the president of Anthem Blue Cross and Blue Shield in Maine, also sent the opinion piece as a letter to our member hospitals.

The opinion piece outlined the state’s Medicaid payment reform efforts and made public Anthem’s desire for our hospitals to share with Anthem the $60 million of potential increases in payments to hospitals.

We are always willing to sit down with carriers and discuss how to make care more affordable to Maine people. We would welcome it. But we would seek a broader conversation than one about Anthem’s desire to profit off the additional Medicaid reimbursement our member hospitals are slated to receive.

As I see it, a broader conversation on the subject would include the following:

• The fact that Maine hospitals haven’t received a Medicaid inpatient payment increase in 20 years and have an annual $230 million shortfall in those payments.

• The fact that the proposed $60 million for inpatient rate increases doesn’t come close to covering that shortfall.

• The fact that the increase in Medicaid reimbursement is only possible because of a substantial increase in the hospital tax paid by our members to the state.

• The fact that over the past several years, Anthem has consistently owed Maine hospitals over $300 million for services provided, which clearly dwarfs the $60 million in additional Medicaid payments.

• The fact that Anthem’s parent company made almost $1 billion in profit in the fourth quarter of 2023 alone.

• The fact that Maine families are bearing the brunt of Anthem’s high deductible plans which ultimately shift insurance expenses back to hospitals.

• The fact that Maine hospitals’ financial condition remains precarious, at best, postpandemic.

• The fact that Anthem continued to collect premiums during the pandemic – while hospital services were either completely shut down or greatly curtailed, resulting in an obvious windfall to Anthem’s bottom line.

I would also like to flag Anthem’s claim that Maine has some of the highest health care costs as not supported by the data.

While we believe there are some fundamental flaws with the methodology underlying the cited study on health care costs by the Rand Corporation, it finds that Maine’s costs are not among the highest in the country. Indeed, Maine’s inpatient and outpatient prices as a percentage of Medicare were below the national average (we ranked 29th).

A more neutral source for cost data comes from the Kaiser Family Foundation. On its state-by-state ranking for hospital costs, Maine ranks 25th and just below the national average. Maine also ranks the lowest in New England.

This is not to say that hospital expenses or health care costs in general are not a legitimate concern. But if we are going to solve a difficult problem, we should start with the facts.

To ask Maine hospitals – even our smallest and most isolated – to give to Anthem their additional Medicaid money, if they get any at all, is brazen in light of these realities. Again, we are always willing to talk about affordability, but only if the discussion is appropriately rigorous and broad.