Sen. Susan Collins all but said she would vote “no” on an Affordable Care Act repeal bill during an appearance at an event in Portland on Friday. Hours later, the bill appeared to be in its death throes after Sen. John McCain, R-Ariz., announced his opposition.

With all Democrats against repeal, Republicans can afford to lose only two votes and still have Vice President Mike Pence cast the tie-breaking vote to eliminate the ACA. Collins, McCain and Sen. Lisa Murkowski, R-Alaska, were the only Republicans to vote “no” in a dramatic late-night vote on July 27, defeating the previous repeal effort by one vote.

“I’m leaning against the bill,” Collins said after listing a series of serious deficiencies in the Graham-Cassidy repeal bill.

“I’m just trying to do what I believe is the right thing for the people of Maine,” said Collins, appearing at the Holiday Inn By the Bay to give a speech about affordable housing.

About 80,000 Mainers are among the roughly 20 million Americans who have ACA insurance.

McCain issued a written statement announcing he “cannot in good conscience” vote for the Graham-Cassidy bill, a critical step that could kill the measure. Murkowski has criticized the bill, but has not yet revealed how she will vote. Sen. Rand Paul, R-Kentucky, is so far opposing Graham-Cassidy from the political right, putting the bill in further peril.

Collins slammed the bill on Friday, pointing out that it undermines pre-existing condition protections enshrined in the ACA.

“I’m reading the fine print on Graham-Cassidy,” Collins said. She said insurers could charge sky-high rates to people with pre-existing conditions. “The premiums would be so high they would be unaffordable.”

Collins said she would likely make her decision early next week, after a Congressional Budget Office analysis of the bill, but she had nothing positive to say about Graham-Cassidy on Friday.

Collins’ speech came on the same day that Gov. Paul LePage of Maine met with Pence, and LePage was pressuring Collins and Sen. Angus King – an independent who caucuses with the Democrats – to vote in favor of Graham-Cassidy.

When asked about LePage, Collins said she welcomes “input from all of my constituents.”

“The governor in particular has stepped up his efforts,” Collins said. “There is a lot of pressure, but I’ve had a lot of pressure on a lot of different issues over the years.”

Collins said she gathers all the data and tries to “make the best decision.”

“If I don’t do that I can’t look at myself in the mirror,” Collins said.

She said rural hospitals would be in great danger of closing if Graham-Cassidy were approved, and held out Charles A. Dean Hospital in Greenville as an example.

“If Medicaid is cut that hospital will not survive,” Collins said. “It’s the biggest employer in town. It has 180 good-paying jobs. So not only would people lose access to health care that they need, it would be a devastating blow to the community. You could go all over the state and find that would be true.”

Republicans face a Sept. 30 deadline to pass Graham-Cassidy, at which point special rules that prevent a Democratic filibuster will expire and 60 votes would be needed. The Republican leadership has been attempting to repeal the ACA, former President Barack Obama’s signature domestic achievement, for seven years.

Another GOP failure to undo the ACA could have a seismic impact on the legislative dynamic in Washington and the emerging contours of the 2018 midterm elections. If Graham-Cassidy fails, Trump could turn on congressional Republicans more forcefully and be tempted to work with Democrats, whom he recently has courted on a series of narrower issues.

Cassidy-Graham would turn funding for the ACA into block grants for states and sharply cut Medicaid spending over time. Three independent analysis have predicted that more than 30 states would lose federal funding between 2020 and 2026 under the measure.

LePage, however, touted a Trump administration analysis that showed Maine gaining Medicaid funds under Graham-Cassidy, and in a Facebook post urged Collins to vote for the bill.

Pence also put pressure on Collins during his meeting with LePage.

“President Trump and I are absolutely determined to carry this case all across the country and to call on members of the Senate – most especially Senator Susan Collins from the great state of Maine – to join us in giving the people of Maine and the people of America a fresh start on health care reform,” the vice president said.

But the Trump administration’s conclusions have been widely discredited by a number of independent analysts, and Collins said her reading of the Medicaid funding also showed drastic cutbacks across the country and in Maine under the bill. Collins said the Trump administration is counting money going in but not money that’s been cut.

“This is a case of the federal government giving with one hand and taking away with the other,” Collins said.

She said she has seen “nothing to contradict” analysis showing cliffs in Graham-Cassidy funding that would kick in after 2026, and that changing the funding formula for Medicaid would be harmful to many states, including Maine. By some calculations, Maine would lose more than $1 billion in federal health care money over the next 10 years.

Collins bemoaned that bipartisan efforts to fix the Affordable Care Act have been dropped. In early September, Collins was working with the Senate’s Health, Education, Labor and Pensions committee on bipartisan solutions to the ACA, but Republican leadership stepped away after prospects for Graham-Cassidy improved.

“We were on our way to producing a bipartisan bill that would have addressed some of these problems. Unfortunately, the Graham-Cassidy bill has derailed that effort at least temporarily. That’s very unfortunate,” Collins said.

She said any bill that addresses health care reform should be bipartisan and undergo “extensive hearings.”

“I don’t think you make fundamental changes in a program that has been on the books for 50 years, the Medicaid program, and that serves our most vulnerable citizens, without holding a single Senate hearing on it,” Collins said. Republican bills to repeal the ACA have been crafted behind closed doors without committee hearings.

McCain also has been calling for committee hearings and bipartisanship.

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said in his statement.

Senate Minority Leader Charles E. Schumer, D-New York, said in a statement that McCain revealed “courage” by opposing Graham-Cassidy.

“I have assured Senator McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process,” Schumer said.

Collins also has introduced a bill with Sen. Bill Nelson, D-Fla., that would stabilize the ACA’s health insurance marketplace.

Collins said her goal is to expand the number of insured Americans, while the Republican bills offered so far would have resulted in millions more uninsured.

“We should not be going backward in this area,” she said.

Three Washington, D.C., think-tanks have estimated that there would be 32 million fewer Americans with health insurance if Graham-Cassidy were approved.

Collins also criticized a tactic, reported by The Associated Press, in which Republican leadership would allow Alaska to maintain the Affordable Care Act as a way to persuade Murkowski to vote for Graham-Cassidy.

“To carve out a special rule that only applies to one state in order to get a senator’s vote is not a good way to make public policy,” Collins said.

Collins’ comments against Graham-Cassidy were praised by Steve Butterfield, public policy director for Consumers for Affordable Health Care, an Augusta health advocacy group.

“She must be under an enormous amount of pressure,” Butterfield said. “It must take a tremendous amount of heart and courage. It cannot be easy.”

But Sue Hawes, of Portland, who joined about 50 people protesting Graham-Cassidy outside the hotel on Friday, was less impressed. She said the uncertainty around the bill was “terrorizing” people who are worried about losing coverage.

“If she’s against it, I wish she would just come out and say she’s against Graham-Cassidy,” said Hawes, who was holding a “Kill the Bill” sign. “Just say it and get it over with.”

With wire service reports.

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

[email protected];

Twitter: joelawlorph