A last-ditch attempt to repeal and replace the Affordable Care Act is gaining steam, but Maine Sen. Susan Collins – who wields a crucial vote in a closely divided Senate – raised deep concerns Monday in advance of a possible vote next week.

The plan, headed up by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, slashes Medicaid, undermines protections for pre-existing conditions and defunds Planned Parenthood, health policy analysts said. The bill comes less than two months after a dramatic late-night vote that some believed meant the repeal fight was over, and less than two weeks before the clock runs out on getting a repeal bill approved with Republican-only votes.

About 20 million Americans have ACA insurance, including 80,000 Mainers. Many of the people who have ACA insurance are self-employed or have part-time jobs that don’t offer insurance.

In a statement, Collins said, “I have a number of concerns with the Graham-Cassidy proposal, including the fundamental changes to the Medicaid program, the effect on premiums for older Americans, and the fact that the bill could allow insurers to charge higher premiums for people with pre-existing conditions.

“In addition, I am very concerned by projections cited by the Maine Hospital Association, which show that the bill would cut Medicaid and other federal health care spending in Maine by more than $1 billion in the next 10 years. I will be examining carefully the forthcoming (Congressional Budget Office) analysis.”

The CBO has yet to officially score the bill, and announced Monday that it would unveil a bare-bones, preliminary analysis early next week.

The bill would result in 32 million fewer Americans with insurance, according to a left-leaning Washington think tank, the Center on Budget and Policy Priorities.

Collins was one of three Republicans to buck the party and vote “no” on ACA repeal on July 27, and she has said that bill would have been a “disaster” for the country for its deep cuts to Medicaid, skyrocketing premiums for older Americans and financial impact on rural hospitals, among other reasons. The ACA repeal attempt failed 51-49 in the Senate, with Republicans Collins, Lisa Murkowski of Alaska and John McCain of Arizona joining all Democrats and left-leaning independents to defeat the bill.

Now a different bill with similar impacts – millions losing health insurance – could come before the Senate.

McCain has not indicated whether he would vote against ACA repeal if it were to come up for another vote.

Read Gov. LePage’s appeal

Collins had teamed up with Cassidy in January on a much more moderate replacement plan that would have permitted states to keep most of the Affordable Care Act and preserved many of the law’s consumer protection mandates. But while Collins has maintained a position in favor of expanding access to health care and against right-wing replacement plans since then, Cassidy has moved to the political right and is now advocating for a bill that would gut Medicaid and result in millions of Americans losing health insurance.

Maine Sen. Angus King, an independent who caucuses with the Democrats, has remained steadfastly opposed to ACA repeal.

“Senator King is committed to pursuing bipartisan solutions that strengthen the Affordable Care Act and protect healthcare for the millions of Americans who rely on the ACA for affordable access to insurance,” said Jeff Sobotko, a King spokesman. “The Graham-Cassidy bill does not achieve this objective, and instead could cut more than $1 billion in (Medicaid) health care funds from Maine over a 10-year period.”

According to Senate rules, the Graham-Cassidy bill would have to be voted on before Sept. 30 to pass by a simple majority. Otherwise, 60 votes and the cooperation of Democrats would be needed.

Simultaneously, Collins is working on the Senate’s Health, Education, Labor and Pensions committee that is contemplating fixes to the ACA. Collins has consistently said that the best way to fix the ACA is to go through the committee process. None of the Republican ACA repeal plans went through congressional committees.

Meanwhile, Gov. Paul LePage, an ACA opponent, sent a mass email sent to Republicans on Sunday, urging constituents to call Collins and King to urge them to support ACA repeal.

“Democrats are about to try and use Obamacare’s failures to have the federal government completely take over the system – if we don’t do something, that could happen,” LePage wrote. “We have one last shot, this week, to get the votes in the United States Senate to save the system from collapse or takeover.”

But Mitchell Stein, a Maine-based health policy analyst, expects Collins will be a “no” vote.

“I am optimistic she would do the right thing and vote against this, based on everything she has said over the past several months,” Stein said.

He said Graham-Cassidy is inferior to the other repeal attempts, which also would have resulted in millions without insurance.

“In some ways, it’s the worst of the bunch,” Stein said. “The insurance companies wouldn’t have to cover people. All consumer protections that are built into the ACA would go away.”

Maine Rep. Chellie Pingree, D-1st District, said in a statement that Republican leadership is “throwing something against the wall in hopes that it will stick while they can still pass it with a simple majority.”

“That’s not a responsible way to write national health care policy that will affect the lives of millions,” Pingree said. “But from what I’ve seen, this bill would be awful for the people in our state. Any way you cut it, this legislation means drastically less assistance to help Mainers access the health care they need. It’s no better than any of the other awful plans that failed in the Senate.”

Emily Brostek, executive director of Consumers for Affordable Health Care, an Augusta-based health advocacy group, said the proposal would eliminate protections for pre-existing conditions, a “scary prospect.”

“We would be going back to a world where an insurance company could deny you coverage or charge you more based on a pre-existing condition,” Brostek said.

Planned Parenthood spokesman Amy Cookson said the bill “blocks patients from going to Planned Parenthood for preventive care, including birth control, cancer screenings, and STD testing and treatment.”

An email sent by a spokesman for Rep. Bruce Poliquin did not expressly say whether the Republican representing Maine’s 2nd District supported Graham-Cassidy. But Brendan Conley said Poliquin would not support repeal “without a viable replacement.”

Poliquin said he has a 14-point plan he would use as a “guideline” if a bill reached the House and came up for a vote.

“Congressman Poliquin has consistently discussed his 14-point plan to help fix the Obamacare ACA law, which has caused Maine people to lose their choice of health plans while premiums and deductibles continued to rise, and also expressed that he will not support a repeal of the law without a viable replacement ready,” Conley said in the email. “His focus remains on those 14 points, and he will use those as a guideline for any plan which reaches the House.”

Conley said Graham-Cassidy is a “work-in-progress” and so Poliquin will wait until a bill is before the House before weighing in.

In May, Poliquin voted for the House version of the ACA replacement plan that would have left 23 million fewer Americans with insurance. That version and all other repeal efforts have failed. Both the House and Senate would have to agree on a bill, and President Trump would have to sign it, before the Affordable Care Act could be repealed and replaced.

Joe Lawlor can be contacted at 791-6376 or at:

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