Medicaid Crisis: State Mismanagement Threatens Care for Seniors

Medicaid is stumbling in Democrat-led states, from Washington to Maine. Reasons are simple. State leaders underfund the formula, give access to illegal aliens, lowball hospital reimbursements, fail to pay bills, require no work, and blame Trump.

Truth is painful, a light in the eyes. Medicaid goes by different names in different states, but it is a federal-state formula that requires responsible state leadership.

Unfortunately, bad management by Democrat-led states drives quality and access down, costs up. That combination has gutted affordable, accessible, quality care.

Democratically led states now face staggering losses at hospitals and nursing homes, medical personnel leaving, bills unpaid, imperiling young and old alike.

Nationally, 338 hospitals are at risk of closing, not because eligibility for Medicaid is now required – no more illegals, no more free coverage of able-bodied adults who refuse to work, go to school, or volunteer – but because state leaders fail.

In places like Maine, which has lost 10 hospitals, 11 birthing units, and 12 nursing homes in recent years, the crisis is accelerating, devastating, and self-inflicted. Democrats for eight years have failed at long-term planning, done everything wrong.

A shortage of primary care physicians, nurses, and specialists – dentists to OBGYNs – has made the state at times unsafe, with reports of Medicaid not covering people in crisis and pregnant women waiting in parking lots for a doctor.

This is a management failure, compounded by incompetence. If state leaders–the governor and agency heads were competent and accountable, and had not run hospitals out of business with unpaid bills, the healthcare world would look very different.

Using Maine – this poorly run, Democrat-led state – as an example, 11 birthing units have closed, four in the past year, from underpaid, disincentivized OBGYN doctors leaving for no backup, no state support on unaffordable housing, taxes.

Four other Maine hospitals are at risk, a fifth redlined by the legislature. The mantra by Democrats – including the Democrat nominee for governor, Hannah Pingree, who thinks birthing centers can be “mandated” without OBGYN doctors – is just to blame Trump.

Does that work here? Losses are not from new eligibility requirements, including no federal coverage for illegal aliens and requiring able-bodied citizens to work to get coverage. No, the real reasons are systemic, preventable, and beyond debate.

The same Democrat nominee for governor who blames the federal government was once a legislative leader – who left an incoming Republican governor with $750 million in unpaid bills to hospitals – an act both irresponsible and unethical.

When that governor paid the debt and was succeeded by a Democrat – for whom the current nominee worked – they failed to pay hospitals on time or the right amount, causing many to go insolvent and close. To be clear, that was not Trump’s fault.

While complaining that thousands will lose healthcare if new eligibility standards are enforced – citizenship and work – the Democrats own the failing hospitals.

Go deeper. Why is this happening? In all states, part of the reimbursement for hospitals is state-set. If the state underpays, fails to pay, or sets reimbursements below the cost of a procedure – for births or addiction services – the provider eventually fails.

In Maine, a familiar example: a healthy birth is $15 to $20 thousand for doctor, nurses, technicians, malpractice insurance, pre- and perinatal. In a recent example, the state paid $4,600.  No one can stay in business taking that loss.

Add to this a feckless, reckless, systemic failure to pay bills on time, constant excuses not to pay, sluicing dollars to other programs, pet projects, and perhaps some of those non-competed contracts, ideological subsidies, and hospital closures.

In the 2020 COVID period, this Democratic governor and her newly nominated aide, the Democratic nominee for governor, demanded medical personnel be fired if they did not take the MRNA shot, now understood to have major side effects.

The bottom line is that any program – even one unwieldy – can be managed well. When it is not, bad things can happen. They are in Maine and other Democrat-led states, demonstrating that Medicaid run by an unaccountable government craters.

Even mainstream media make the point. In Maine, for example, leading papers have reported the failure for years, even during the Biden era.

The Maine Monitor reported in 2024: Medicaid “reimbursement rates fall about $40 short of the cost of care per resident per day,” while the head of the developmental disabilities group shut down said: “This program is no longer financially sustainable given the current reimbursement rates and staffing difficulties.”

Democratic leadership mismanagement of mental health services was reported thus: “Reimbursement rates for mental health services from Medicaid were not high enough for Sweetser to offer therapy services at the five clinics.”

A private group that closed eight nursing homes, reported eight years ago: Medicaid “reimbursement rates fall about $40 short of the cost of care per resident per day,” while The Bar Harbor Times reported “Hospital administrators said that reimbursement rates … which covers 37 percent of all births in the state, do not approach the high fixed costs of running a labor and delivery unit.”

In 2025, after a major Maine hospital closed, the Democrat governor proposed more cuts to reimbursement rates that “…a 36 percent cut to payments to doctors for Medicaid services over the next five years … costing hospitals $24 million per year once the cuts are in full effect.”

Bottom line: Mismanagement of Medicaid – before we get to fraud – is stunning and requires serious oversight. Blaming Trump is more dissembling, unaccountable leadership.