U.S. Sen. Susan Collins of Maine and four fellow Republican senators are leading an effort to slow down the process underway in the Senate to repeal the Affordable Care Act.

The amendment sponsored by Collins could pump the brakes on a repeal of the federal health care law – and could be a crucial moment in the future of the law, experts say.

As a moderate Republican holding a key vote in a closely divided Senate, Collins wields a lot of influence. Her statements criticizing her fellow Republicans’ efforts to “repeal and delay” the law – first made to the Press Herald in early December – were among the first from Republican senators casting doubt on the party’s strategy to kill the ACA and delay a replacement plan for years.

Since then, several other Republican senators also have questioned the wisdom of immediately repealing the ACA without having a replacement plan in hand. Republicans hold a narrow 52-48 majority in the Senate.

“Whether the ACA survives is going to depend on a handful of votes in the Senate. So in regards to whether the ACA lives, Susan Collins might be the most important person in America,” said Mark Brewer, a political science professor at the University of Maine. “Certainly everything she says will be carefully and closely watched.”



More than 20 million Americans have gained health insurance under the ACA – including about 80,000 in Maine – and enrollments for 2017 are on pace to surpass last year’s sign-ups. If the ACA were to be repealed without a replacement in place, the United States would lose 2.6 million jobs in 2019, including 13,000 in Maine, according to a study by the nonprofit Commonwealth Fund, a New York-based health policy research foundation.

During a quick interview with the media Tuesday in the halls of Congress, Collins said that “insurance markets are complicated” and “we want to make sure we get it right.”

“We want to make sure we put a system in place that is far superior than what we currently have,” she said.

To accomplish the Republicans’ goal of “repeal and replace” simultaneously would be politically and logistically difficult, said Gary Claxton, vice president of the Kaiser Family Foundation, a Washington, D.C.-based health policy think tank.

Under Senate rules, a simple majority would be needed to repeal the funding for the ACA, but a replacement would need at least a 60-vote total that would require the cooperation of several Democrats. Claxton said even among the Republican caucus, lawmakers have yet to coalesce around a replacement plan.

Claxton said the realization that replacing the health care law would be difficult is leading to calls by Collins and others to slow down the efforts to dismantle it. Joining Collins in sponsoring the amendment were Republican Sens. Bob Corker of Tennessee, Rob Portman of Ohio, Bill Cassidy of Louisiana and Lisa Murkowski of Alaska.


“When you quickly destroy what’s there, the blame lies squarely on the people who took it out,” said Claxton, a former deputy assistant secretary for health policy in the Clinton administration.

The Senate is currently undertaking a complicated “budget reconciliation” process that could strip funding for the ACA. The amendment supported by Collins puts off a key part of the process – language drafted by committees that would craft the details of what an ACA repeal would look like – from Jan. 27 to March 3.


There are other signs that a quick repeal might not happen.

House Speaker Paul Ryan said Tuesday that Republicans will repeal and replace the ACA “concurrently,” according to media reports.

“We’re going to use every tool at our disposal – through legislation, through regulation – to bring ‘replace’ concurrent along with repeal to save people from this mess,” Ryan told reporters in the Capitol. Also, President-elect Donald Trump told The New York Times that he believes a replacement plan should be voted on “simultaneously” or shortly after a repeal vote. “It won’t be repeal and then two years later go in with another plan,” Trump said.


However, in the same interview Trump also said that he wants the Senate to repeal the ACA next week, with a replacement plan “shortly thereafter,” but he has given no indication of what a replacement plan would look like.

Meanwhile, independent Maine Sen. Angus King joined Democrats for an overnight “talk-a-thon” on the Senate floor Monday night with impassioned pitches to save the ACA. The Affordable Care Act has reduced the uninsured rate from 17.1 percent in 2013, before the law’s individual marketplace went into effect, to 10.9 percent in the third quarter of 2016, according to a Gallup poll.

The number of Mainers with ACA coverage in 2017 is expected to increase by about 10 percent over the 80,000 who had it in 2016.

The individual marketplace is designed for those without employer-based coverage – such as self-employed lobstermen – to obtain subsidized insurance benefits.

Collins has said she doesn’t want people to lose their health care coverage during an interim period that could last years while Congress debates how to replace the ACA.



Even if Congress votes to delay implementation of the repeal for two to three years, experts say the individual insurance markets that keep the ACA functioning would be in danger of collapsing without another plan in place because insurers would likely leave the market.

“The prospects of destabilizing the insurance markets is starting to dawn on people,” Claxton said.

Three former Maine insurance superintendents – Mila Kofman, Alessandro Iuppa and Brian Atchinson – wrote an op-ed for the Press Herald that said repealing the ACA without having a replacement would likely collapse the Maine market and have “terrible consequences for thousands of Maine citizens.”

Collins, in a written statement Tuesday, recognized the complexity of insurance markets.

“Repeal and replacement is a complicated task, and my number one concern is that we not create a gap in coverage for individuals who are currently insured and who rely on that coverage,” she said. “By providing more time to come up with legislative solutions, we have a better opportunity to produce a thoughtful, workable replacement that ensures Americans have access to affordable, diverse insurance plans that meet their needs.”

King, during his overnight Senate floor speech, said any plans to repeal without a substantial replacement would be “repeal and chaos.” He said having health insurance saved his life in 1974 because a preventive screening detected the early stages of an aggressive form of skin cancer.

“For the life of me, I cannot figure out why anyone would want to take health insurance away from millions of people. It is a death sentence for some significant percentage of those people,” King said during his Senate speech. “Let’s slow down and talk about how to fix it, how to change it, how to replace it.”


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