The majority of Mainers want the government involved in health care. How do we know?

• By listening to the crowds that cheered Sen. Susan Collins when she came back home after casting one of the deciding votes against her own party’s “reform” bill, which would have cost 23 million Americans their health insurance.

• By counting the votes in this month’s election when Medicaid expansion under the Affordable Care Act was endorsed by nearly 60 percent of the people who went to the polls.

• By watching the rate at which Mainers are signing up for individual insurance plans through the ACA marketplace, despite deliberate attempts to sabotage the program by the Trump administration, which slashed its marketing budget and cut the open enrollment period in half.

Now, Republican tax reformers in the Senate are attacking the ACA again, this time proposing the elimination of the individual mandate, a maneuver that would add 13 million Americans (and an estimated 50,000 Mainers) to the ranks of the uninsured so they can fund tax cuts for the wealthiest individuals, families and corporations. No one paying attention during these last few months could think that’s what the majority of Mainers want to see happen.

Especially since there are troubling trends in the health care market that have nothing to do with “Obamacare,” but have everything to do with America’s outlier status as the most expensive place in the world to get health care. If members of Congress are really interested in helping the middle class, they should be advancing ideas to bring U.S. health care costs into line with other developed nations’, not tax rate cuts for corporations.

The cost problem has come into focus in the last few years as more employers control their spending by switching to high-deductible health insurance plans, where consumers pay most of the initial costs out of pocket before the insurance company starts to contribute. Deductibles for people with employer-supplied insurance have nearly tripled in the last decade. As a result, more consumers are seeing for the first time the real prices of all the medications and procedures that they used to be able to access with an affordable co-pay, and they’re getting sticker shock.

The same dynamic is happening on the ACA exchanges, where people whose income makes them eligible for subsidies are being offered low-premium and even no-premium plans that have deductibles as high as $3,000 for an individual.

This can be a great deal, especially for healthy young people, who are probably not going to need much health care during the year, but should have coverage in case they have a major illness or accident. By signing up for a no-premium plan, their subsidy will be used to keep them in the insurance pool, which protects them from a catastrophic loss and helps maintain lower premiums for everyone else. But these plans create a problem for the consumer who might not have a few thousand dollars available to pay for a test that their doctor ordered after a fully covered annual physical.

Candidate Donald Trump used these trends as a club to beat on Obamacare, telling people that their skyrocketing out-of-pocket expenses were caused by the Democrats’ health care reform.

The truth is something else, but also troubling. It’s not just the way that costs are shared between consumers and insurance companies that has changed – so has the overall cost of health care itself, which has increased by 55 percent over the last decade.

The ACA has slowed the growth of health care spending, but the costs were too high to start with. Americans pay twice what residents of other developed countries pay for the exact same services, and it’s the cost of care itself that presents the biggest barrier to accessing health care – bigger than whether insurance is public or private, or whether there is a single payer or multiple payers.

Attacking health care costs is where Congress should be focusing its energy. Instead, most of this year has been consumed with attempts by the government to wiggle out of its commitments and leave more people to fend for themselves.

That’s not what the country needs, and it’s not what Mainers want. Members of Congress should be focused on changes that would bring health care costs down for everyone.

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