Health care in Maine is not working the way it can or should. Too many families are paying more and getting less, fighting insurance companies for care their doctors already know they need, and worrying about whether they can afford to stay healthy, let alone get sick. At the same time, communities across our state — especially rural communities — are facing growing challenges in recruiting and retaining doctors, nurses, and other providers. High costs, administrative burdens, and uneven support make it challenging to provide care in some parts of Maine, even as the need continues to grow.
This plan is grounded in the principle that health care is a human right, not a privilege. Guided by that core belief, health care should be built around a simple set of values: care should be affordable, accessible, grounded in science, and delivered with dignity. Medical decisions should be made by doctors and patients — not insurance companies. Public health decisions should be made based on evidence, not politics. And no one should be forced to choose between getting care and paying the bills.
This plan is about making health care work better for Maine people — now and in the years ahead. It focuses on practical steps we can take today, guided by evidence, compassion, and a clear sense of responsibility to care for another, as Mainers always have.
-Dr. Nirav Shah
Executive Summary: Dr. Shah’s Plan to Make Health Care More Affordable in Maine
- Cap insurance copays and deductibles to deliver immediate cost relief for Maine families.
- Put doctors—not insurance companies—in charge of medical decisions by ending prior authorization for routine and ongoing care.
- Lower prescription drug prices by capping excessive costs for essential medications.
- Make big insurance companies pay their fair share to stabilize rural hospitals and protect essential services.
- Train and recruit more doctors, nurses, and providers—especially in rural communities.
- Expand and protect access to women’s health care by stabilizing maternity services and training more OB-GYNs, midwives, and nurses.
- Protect science-based public health and keep politics out of health decisions.
Lower Costs for Patients and Families
Cap Insurance Copays and Deductibles to Deliver Immediate Cost Relief for Maine Families
- Cap insurance costs using Maine’s existing authority: Update Maine’s insurance laws to cap copays and deductibles based on income for plans the state already regulates — using the same rate-approval system Maine uses today.
- Stop insurance companies from gouging families by expanding the powers of the Maine Bureau of Insurance to deny excessive rate hikes, block high-deductible cost-shifting plans, require refunds when insurers overcharge, and impose real penalties when they break the rules.
- Apply these protections everywhere Maine has authority: Including individual and small-business plans, fully insured employer plans, and public employee coverage.
Lower the Cost of Prescription Drugs
- End excessive price hikes for prescription drugs by giving the Maine Prescription Drug Affordability Board the authority to set binding caps on the cost of essential medications.
- Lower prices for the medications people rely on every day: Direct the Board to prioritize life-saving and chronic-care drugs for conditions like asthma, diabetes, blood pressure, heart disease, and mental health, where high prices force people to ration or skip care.
- Make sure price caps actually reduce costs at the pharmacy counter: Apply these limits to state-regulated health plans and public employee coverage, with safeguards to prevent shortages and ensure pharmacies and patients are protected.
Keep Insurance Companies Out of Medical Decisions
- Put doctors—not insurance companies—in charge of medical decisions: Change Maine’s insurance laws so insurers cannot deny or delay care that a licensed clinician determines is medically necessary or is consistent with evidence-based standards of care, except in narrow, clearly defined situations.
- End prior authorization for routine and ongoing care including hospital stays, non-emergency maternity care, vaccines, primary care, chronic disease treatment (like diabetes), reproductive health care, and expanded behavioral health. If a doctor says a patient needs care—or is stable on a treatment—they should get it without insurance company interference.
- Require real medical review where prior authorization is allowed: When prior authorization is legally permitted, require that any denial be made by a Maine-licensed clinician in the same or similar specialty as the treating provider—NOT by algorithms or out-of-state providers—and include a written medical explanation.
- Strengthen Maine’s existing prior authorization deadlines by requiring insurers to respond to urgent requests within 48 hours instead of the current 72.
- Hold insurance companies accountable: Strengthen the Maine Bureau of Insurance’s authority to audit denial patterns, impose real penalties for abusive practices, and expand public reporting on how often insurers deny doctor-recommended care.
Make Big Insurance Companies Pay Their Fair Share
- Increase taxes on large health insurance companies and direct that revenue to stabilize rural hospitals and avoid additional closures, protect maternity services, and expand access to care in underserved communities.
- Use new insurance company revenue to support providers that serve large numbers of Medicare, Medicaid, and rural patients.
Expand and Strengthen MaineCare
- Expand MaineCare so more families get affordable coverage instead of facing high premiums, deductibles, and medical debt.
- Strengthen MaineCare to support rural hospitals, recruit providers, and keep care close to home.
- Ensure doctors, nurses, and mental health providers can afford to practice in every part of Maine.
Train and Keep More Health Care Workers in Maine
Train Here, Stay Here
- Expand clinical training and residency capacity across the state: Pass legislation to fund at least 150–200 new clinical training slots and residency positions over four years, allowing more Maine hospitals—especially rural hospitals—to serve as approved training sites.
- Invest where training leads to long-term jobs: Direct new funding to hospitals and health systems that partner with Maine-based training institutions so more students can complete clinical rotations and residencies in the communities where they are most likely to stay and work.
- Level the playing field for rural hospitals: Use state dollars to help smaller and rural hospitals cover the costs of supervision, accreditation, and infrastructure required to host trainees—opportunities that today only a few large hospitals can afford.
- Grow Maine’s workforce from within: Tie expanded funding to in-state service commitments, strengthening the pipeline from training to permanent practice and ensuring public investment results in more health care providers living and working in Maine.
Expand Loan Repayment Programs to Attract and Keep Providers
- Expand Maine’s existing loan repayment programs: Grow and modernize the health care loan repayment programs already run through the Finance Authority of Maine so they reach more doctors, nurses, dentists, behavioral health providers, and allied health professionals.
- Direct loan repayment to rural and high-need communities, using larger awards to help close the income gap between practicing in rural Maine and higher-paying markets — so providers can afford to stay where they’re needed most.
- Reward long-term service, not short stints: Increase loan repayment support with each additional year a provider practices in a rural or underserved area, encouraging people to put down roots, build practices, and stay in Maine long term.
- Prioritize loan repayment for mental health and substance use providers, including psychiatrists, psychologists, social workers, and counselors in rural and underserved communities.
- Coordinate state and federal support to maximize impact: Align Maine’s expanded loan repayment programs with existing federal options so providers can combine supports, making rural practice financially realistic without duplicating costs or bureaucracy.
Make It Easier for Providers to Practice in Maine
- Cut licensing red tape by expanding reciprocity and streamlining approvals for qualified providers from other states.
- Speed up approvals without lowering standards: Modernize and align licensing rules through Maine’s professional licensing system, reducing duplicative paperwork and long waits while keeping patient safety and professional standards strong.
Protect and Expand Access to Women’s Health Care
Protect and Expand Care
- Protect access to the full range of reproductive and preventive health services under Maine law.
- Stabilize and protect maternity services at rural and community hospitals so families don’t have to drive hours to reach a birthing center.
- Expand prenatal, postpartum, and preventive care through community clinics, telehealth, and mobile services in underserved areas.
- Expand access to birth control by making certain pills available without a separate doctor’s visit, including pharmacists prescribing statewide, and pursuing additional over-the-counter access as federal rules allow.
Train and Recruit More Women’s Health Providers
- Expand training and residency slots for OB-GYNs, midwives, and women’s health nurse practitioners across Maine.
- Increase loan repayment and scholarships for providers who commit to working in rural and underserved communities.
- Support team-based maternity care models that use nurses, midwives, and family physicians to expand access safely.
Protect Public Health
Follow Science-Based Vaccine Policy
- Base vaccine policy on science, not politics — following the evidence and consensus of trusted national medical organizations like the American Academy of Pediatrics and the American Medical Association — not politically driven federal reversals that put public health at risk.
- Protect and expand access to routine and life-saving vaccines, ensuring Maine continues to support childhood and adult vaccination so preventable diseases stay prevented and communities stay healthy.
Environmental Health: Clean Air and Clean Water
- Treat clean air and clean water as core public health priorities, strengthening protections that keep Maine’s air and drinking water safe, recognizing their direct impact on asthma, heart disease, cancer, and child health.
- Prevent harm before it happens and prioritize monitoring, enforcement, and prevention so pollution and contamination don’t put Maine families at risk in the first place.
Stand Up for Maine’s Public Health
- Stand up to any federal administration that puts Mainers at risk: When the Trump administration or any federal government undermines science-based public health standards, we will stand up for Maine people and challenge policies that threaten their safety.
- We will use Maine’s authority to protect people and communities, acting whenever state law allows to uphold public health protections, preserve access to care, and keep politics out of decisions about people’s health.
Our North Star: Universal Care for Every Mainer
Health care should be a human right — not a business model built on denying care. Any system where private insurance companies profit by delaying or rejecting medically necessary treatment is fundamentally flawed and, too often, inhumane. It puts corporate incentives ahead of patients, forces families to fight for care during their most vulnerable moments, and puts lives and health at risk.
I’m clear-eyed about the reality: moving to a truly universal health care system will take time, careful planning, and federal cooperation. But acknowledging that universal care is hard is not an excuse to accept a system that fails people every day. Universal care must be our ultimate goal — and we can begin building toward it now.
How We Start Building Toward Universal Care in Maine:
- Build on the work already underway in Maine: the research, planning, and legislative efforts advanced by groups like Maine AllCare have shown that a universal, publicly accountable health care system is both achievable and necessary to guarantee coverage for every Mainer.
- Reduce the role of profit-driven insurance over time: Take concrete steps now to limit the ability of private insurers to deny care, shift costs onto patients, or prioritize profits over people — while expanding public oversight, affordability standards, and patient protections.
- Strengthen public and state-regulated coverage options: Invest in state-regulated plans and public programs that prioritize access, affordability, and continuity of care, demonstrating that health care can be delivered without financial barriers or perverse incentives.
- Prepare Maine to act when federal pathways open: Position the state to move quickly if and when federal law allows states to combine federal health care dollars into a unified system — ensuring Maine is ready to lead, not lag, in delivering universal care.
The goal is a health care system where everyone is covered, no one is denied care because of cost, and medical decisions are made by doctors and patients — not insurance companies.