As Mainers and millions around the country anxiously await news on whether yet another last-ditch Republican effort to repeal the Affordable Care Act has the votes to move forward before a procedural deadline on September 30th, all eyes are once again falling on Maine’s Sen. Susan Collins, who joined Democrats and GOP Senators McCain and Murkowski to put a stop to the previous repeal attempt in the Senate.

While Collins has been characteristically coy about her ultimate voting position on this new repeal attempt, known as Graham-Cassidy. She has indicated that she is leaning toward voting no on the bill, which would likely doom Republican plans to kill the ACA until at least next year. Her official position, however, is that she is still weighing her options.

With that in mind, what follows is a list of reasons that Collins should immediately announce her opposition to this bill—a list provided by none other than the senator, herself, when she laid out her rationale for voting against the previous GOP healthcare disasters that were the AHCA and its Senate cousin the BCRA almost exactly two months ago.

1: “[T]he bill would make sweeping changes to the Medicaid program – an important safety net that for more than 50 years has helped poor and disabled individuals, including children and low-income seniors, receive health care.”

Collins first charge against the AHCA was that it would systematically dismantle the national Medicaid program, which covers over 250,000 Mainers and over 74 million people across the country. But while the AHCA would have reduced Medicaid enrollment by some 14 million people over 10 years, Graham-Cassidy would actually go farther in wrecking Medicaid.

Like the AHCA, Graham-Cassidy would cap state Medicaid funding per-capita, forcing states to pick up the tab if patients exceed that funding limit and reducing federal healthcare spending by billions of dollars. By Collins’ own standards this should be enough to sink the bill, but, Graham-Cassidy goes beyond even these cuts by turning all of the healthcare subsidy money allocated to states for the ACA marketplaces and Medicaid expansion into a single block grant, allowing states to opt out of covering Medicaid expansion recipients entirely with these federal funds.

To add insult to these injuries, Graham-Cassidy would then cut the overall amount of the state block grants in the next 10 years, reducing federal healthcare funding even further.

2: “The non-partisan Congressional Budget Office (CBO) projects that the number of uninsured Americans would climb by 23 million under this bill.”

In her statement rejecting the BCRA, Collins made a point of emphasizing how deeply the bill would impact health insurance enrollment over the next decade, citing the tens of millions that would either lose coverage under the new plans or find coverage so unaffordable that they would not be able to sign up in the first place, citing CBO reports that painted a stark portrait of American healthcare a decade from now.

Although this Graham-Cassidy has actually been brought to the Senate so quickly that a full CBO score will likely not be available until after the September 30 voting deadline, independent analyses are beginning to fill in the gaps. An analysis by the Brookings Institute estimates that the enrollment cuts created by the AHCA and BCRA will largely carry over to Graham- Cassidy, with roughly 21 million fewer Americans covered by health insurance in 2026 than under current law.

Collins could hypothetically argue that that’s 2 million fewer without coverage than the cuts in the AHCA, but we’re still talking about a population over 16 times larger than the state of Maine cut out of the health insurance market under this bill.

3: “Also included in all of these plans is a misguided proposal that would block federal funds, including Medicaid reimbursements, from going to Planned Parenthood.”

Collins made an admirable and principled defense of Planned Parenthood in her July 28 statement, writing that barring Medicaid reimbursement to Planned Parenthood would be “misguided” and that “[m]illions of women across the country rely on Planned Parenthood for family planning, cancer screening, and basic preventive health care services.”

This point remains no less true for Graham-Cassidy, which contains the same nonsensical language as the previous bills, stripping Planned Parenthood’s ability to provide essential healthcare services for millions of men and women by freezing federal reimbursement for its healthcare services. There’s no way Collins can avoid this fact.

4: “We’re dealing with an issue that affects millions of Americans and one sixth of our economy, and we need to approach reforms in a very careful way. That means going through the regular process of committee hearings[.]”

Echoing Sen. McCain’s stirring call to return the Senate to “regular order,” rather than ramming massive bills through the chamber with minimal debate, Collins did some work to re-establish her tarnished legacy as an “institutionalist” in the Senate legitimately concerned about good process.

But if Collins took issue with the sloppy, secretive, and rushed atmosphere of previous ACA repeal attempts, Graham-Cassidy trumps them all.

Not only was this bill introduced the public only a week ago, but because it is technically being introduced onto the floor of the Senate as an amendment to the BCRA, it will receive less than two minutes of debate when it is brought to the Senate floor. It will take you more time to read this article than this bill—which would completely reshape one-sixth of the American economy—will receive on the Senate floor.

Nevermind that Republicans are dead-set on rushing the bill to the floor in less than seven days, bringing the total period of consideration of the bill to about two weeks. Just for reference, debate on the ACA lasted for over a year. There is simply no way that Collins can support this bill and ever again claim to have any concern whatsoever for the process and norms of the Senate, because this bill represents the farthest departure from regular order that one could possibly imagine.

So thank you, Senator Collins, for providing us with all of the reasons you could ever need to vote against this horror of a bill. I really couldn’t have said it better myself.

The preceding originally appeared on, a website and podcast created by progressive group the Maine People’s Alliance.

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