WATERVILLE — Northern Light Health has cut down on staffing costs by not replacing more than 90 employees who left their positions over the last few months, leaders from the health care system said.

Already struggling to recover from a year of steep revenue losses, Northern Light Health is preparing for further financial fallout from the One Big Beautiful Bill Act, signed into law by President Donald Trump on July 4.

The bill makes the deepest ever cuts to Medicaid, resulting in an estimated 1.8 million individuals in rural communities across the country losing health coverage by 2034, according to the American Hospital Association. Roughly 40,000 people in Maine will become uninsured over the next 10 years as a result of the bill, according to KFF, a health policy think tank.

Those changes could be crippling for Northern Light Health, which relies on Medicaid and Medicare insurance coverage for 66% of its revenue, said Lisa Harvey-McPherson, vice president of governance relations at Northern Light Health.

Northern Light Health operates nine hospitals and more than 100 health care facilities in Maine, employing around 10,800 people. The system lost $156 million in its most recent fiscal year, according to a January financial performance presentation.

The losses have forced leadership to make changes, including not hiring for open positions in recent months, said Paul Bolin, executive vice president and chief people and administrative officer at Northern Light Health.

“As people leave, do we need to replace them?” Bolin said. “That’s been a bunch of this work up to this point. We reduced a little over 90 employees just in the last few months, simply by not replacing people who’ve left, and figuring out: How do we surround the work differently?”

The closure of Waterville’s Northern Light Inland Hospital in June resulted in 309 layoffs. A handful of Inland primary care providers, nurses and specialists shifted to other hospitals in the Northern Light Health system, but hundreds of employees working in housekeeping, food service, laboratory and other positions were left unemployed.

Cokie Giles, president of the Maine State Nurses Association, which represents nurses across the state, urged the health care system to prioritize its workers and patients.

“Union nurses at Northern Light facilities stand united for our patients against any threats to their safety or care,” Giles, who is a registered nurse, said in an email Wednesday. “We caution Northern Light to not balance its books on the backs of its patients or staff.”

Despite reports from national researchers that have flagged rural hospitals like Northern Light Maine Coast in Ellsworth and Northern Light A.R. Gould in Presque Isle as being at risk of closure, Bolin said they have no plans to close any other hospitals.

The only surviving facility under Inland is Northern Light Continuing Care Lakewood in Waterville, a long-term care facility that will soon be operated under a joint venture partnership between Northern Light Health and First Atlantic Healthcare, a for-profit health care company that provides services to senior populations. The two companies co-operate six other long-term care facilities in Maine.

With a not-for-profit health care model and fixed costs for many services, Bolin said Northern Light Health is limited in how it can make up for lost revenue. He said leadership plans to continue paying competitive wages while looking at other ways to cut costs.

“We need to make sure our costs are in line,” Bolin said. “And that includes looking at how we perform services, where we perform services, our leadership overhead, the back office work that we do.”

The budget reconciliation bill reduces federal funding to MaineCare, Maine’s Medicaid program, by an estimated $5.9 billion over the next 10 years, Gov. Janet Mills said in a June 25 letter.

Harvey-McPherson said MaineCare will “still have to balance their budget,” which may mean rate reductions or service cuts.

“How MaineCare handles those decisions will tell us what the downstream effect is,” Harvey-McPherson said. “Will more people be uninsured? That’s pretty clear. But will we have rate reductions and will we have service lines that simply won’t be paid for? That we don’t know.”

The bill will also cause an estimated 3,000 immigrants in Maine to lose Medicaid coverage by late 2026, while new work requirements beginning in 2027 are estimated to cause more than 31,000 people in Maine to lose coverage, according to a recent impact summary from representatives at the Maine Department of Health and Human Services.

Administrative burdens will also cut eligible individuals out, the report said.

UNDER PRESSURE

The budget bill isn’t the only piece of legislation putting financial pressure on hospitals, Harvey-McPherson said. A bill signed into state law in early July requires hospitals to provide a higher threshold of charity care to patients.

Hospital charity care provides free or discounted services to patients who are unable to afford care. The bill requires hospitals to provide free, medically necessary care to patients with incomes that are equal to or less than 200% of the federal poverty level — currently $64,300 for a family of four — up from the previously mandated 150%.

Small, rural hospitals that already struggled to provide charity care may not be able to incur greater costs, said Harvey-McPherson, who has spoken out in opposition of the charity care threshold bill along with other Northern Light Health leaders.

“There are a lot of small, independent rural hospitals in Maine that are very, very challenged in their meeting the law,” Harvey-McPherson said. “So we felt it was not the time to pass the most sweeping change in our charity care laws, knowing what was coming.”

With people expected to lose insurance coverage under the budget reconciliation bill, Harvey-McPherson said Maine’s hospitals will have to provide charity care to an even larger group under the new income spread.

“It’s one of those really tough issues in health care, because there will be more people who don’t have health insurance and now more people will qualify for charity care,” she said. “At the very same time, the hospital providers will have their revenues go down significantly, and our cost structures are high. We’re trying to reduce our cost structure to match our revenues, and then here will come a new cost burden based on the law that the legislature passed.”

One lifeline for rural hospitals in the federal budget bill is the $50 billion rural health care fund, which, starting in 2026, will distribute $10 billion a year across all states for five years.

Until that relief comes, Northern Light Health representatives say they are are working to strengthen rural partnerships. Those efforts include providing EMS backup to rural communities, entering into mutual aid agreements and expanding care for patients in remote areas, said Marie Vienneau, senior vice president and regional president of Northern Light CA Dean and Mayo Hospital.

“We are actually working as a system to talk about: How do we train more doctors in rural Maine?” she said. “How do we provide for telemedicine programs, other types of programs that can be provided to rural Mainers who don’t have access to care?”