LEWISTON — After voting against a series of proposals to repeal the Affordable Care Act, Sen. Susan Collins received a spontaneous standing ovation at the Bangor airport from her constituents.

We all breathed a sigh of relief because these bills would have made devastating changes to Medicaid that would have hurt patients and their families for years to come. We were proud that she demonstrated the independence and levelheadedness to vote with her constituents, not her party, in mind.

As it turns out, our relief was short-lived. Congress is poised again to vote on legislation that will repeal a critical provision of the ACA, force $25 billion in automatic cuts to Medicare and pave the way for $1 trillion in cuts to Medicaid over the next 10 years. But this time, Sen. Collins plans to vote “yes.”

Collins has already voted once in favor of the Senate tax bill responsible for these impacts, trading her vote for reassurances that the final version will include fixes that she believes will remedy the damage to health care. Unfortunately, it sounds like she made a bad deal: Those fixes will not address the damage, and Mainers will still be left holding the bag.


The nonpartisan Congressional Budget Office announced last week that the bipartisan bill introduced by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., which would temporarily restore subsidy payments to ACA insurers, would have virtually no impact in reducing premiums or coverage losses caused by the tax bill. The partial repeal of the ACA will result in 13 million more uninsured people, including 50,000 more in Maine, and premium increases of 10 percent for ACA enrollees.


The bill negotiated by Collins and Sen. Bill Nelson, D-Fla., the second component of Collins’ deal, would have a similarly limited impact on the devastation caused by the tax bill.

Experts at the Center on Budget and Policy Priorities note that while the Collins-Nelson proposal – which temporarily helps ACA health insurers cover particularly expensive patients – is a sensible stand-alone measure, it will not undo the damage done by repealing the ACA’s individual responsibility provision. Compared with the over $300 billion cut from health care because of the repeal, the Collins-Nelson bill’s $4.5 billion for reinsurance is a drop in the bucket that can do little to address the loss of coverage and the increase in premiums that will affect millions.

If Sen. Collins, typically a savvy negotiator, was looking for real fixes for the tax bill, she’s missed the mark. As a doctor, I’m worried that the real losers in this exchange are Collins’ constituents – my patients. I am a family physician working with some of Maine’s most vulnerable citizens: the working poor, the elderly and the disabled. Every day, I see people deciding between medications and food, between recommended treatments and paying their rent. More and more often, patients are calling in for advice hoping to avoid a bill for the doctor’s visit.


Both Medicaid and the ACA are critical sources of health care for Mainers, including many of my own patients. Sen. Collins doesn’t have a fix for the trillions of dollars that will be cut from Medicaid and Medicare to pay for the massive tax giveaway under this bill. Medicaid is the largest source of federal funding to Maine. A cut to federal Medicaid not only hurts Mainers most in need of health care – seniors, children and people with disabilities – but also creates significant new burdens for our state budget, potentially forcing cuts in other services in order to make up for shortfalls in Medicaid.

And, of course, Medicaid and Medicare cuts will cause people to lose coverage and services they need to stay healthy. Over 267,000 Mainers depend on Medicaid. Although most Medicaid enrollees in Maine are children and adults under the age of 65, the largest share of spending in the program goes to those with the greatest health care needs: seniors and people with disabilities. Forty percent of low-income seniors and people with disabilities who get health care from Medicare also receive Medicaid.

In Maine, where seniors make up a significant portion of the population, Medicaid and Medicare will only become more critical over the next decade. The last thing Congress should be doing is cutting these programs to give tax breaks to the largest multinational corporations and the wealthiest 1 percent of households and then making seniors, children, people with disabilities and the middle class pay for it.

Sen. Collins’ deal can mask neither the tremendous problems with the Republican tax bill nor the damage to health care it causes. This bill can’t be fixed, and she should reconsider her vote and reject it altogether.

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