Sen. Susan Collins has been consistent in her reasons for opposing Republican bills to repeal the Affordable Care Act this year. Her standard, set in June, is simple, and appropriate: A Senate bill should not reduce the number of people with health insurance. It should not raise costs or put rural hospitals at risk.
Just as previous Republican repeal bills failed this test, so does the most recent iteration, a bill sponsored by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. This bill would dismantle the Affordable Care Act’s system of exchanges by ending subsidies that help people afford insurance on the individual market, and it would end Medicaid expansion, instead giving each state a set sum of money, leaving states to create a whole new mechanism to provide health insurance — mostly with less money.
Collins has been saying for days that she is leaning against voting for the measure. But to lure her into voting yes, Graham and Cassidy revised the bill over the weekend to direct additional short-term funding to Maine and Alaska. Alaska is the home of Republican Sen. Lisa Murkowski, who has joined Collins in voting against previous repeal bills.
The additional funding does nothing to ameliorate the long-term damage that the Graham-Cassidy bill would bring upon Maine and many other states. Beginning in 2026, Medicaid spending would be capped, without consideration of the health status or age of residents. Currently, one in five Maine residents is covered by Medicaid.
“It is hard for me to envision getting to yes on this bill, because my concerns are so fundamental,” Collins said Sunday on CBS’ “Face the Nation.”
She again reiterated those concerns: that the Medicaid cuts, which have not been thoroughly analyzed, would likely have a devastating impact on low-income seniors, disabled children and other vulnerable Maine residents; and that the bill weakens protections for people with pre-existing conditions, such as asthma, diabetes and cancer, and that if insurance is available to people with such conditions, it would be unaffordable.
Overall, premiums also could rise under Graham-Cassidy, pricing millions of Americans out of the insurance markets.
Analysis of previous Republican repeal bills have found that up to 32 million fewer Americans would have health insurance in the next decade than if the current law stayed in place.
The Congressional Budget Office is currently assessing the consequences of Graham-Cassidy, but GOP leaders are in such a hurry to vote on the measure that the budget office says an analysis it plans to release this week will be incomplete, especially with regard to coverage and premiums, the most important aspects of the bill. Under Senate rules, Republicans have until Sept. 30 to pass a repeal measure with only 51 votes. After that date, they would need 60 votes, which means gaining support from Senate Democrats, all of whom have voted against this summer’s repeal bills.
If Republicans were truly concerned about earning the support of Collins, Murkowski and Sen. John McCain — the three senators who doomed a previous appeal attempt in late July — they would address their concerns. Bribes and skewed analysis aren’t going to sway Collins, who oversaw Maine’s Bureau of Insurance and understands the nuances of the repeal bills, perhaps better than their authors.
Rather than remake America’s health care system, which accounts for one-sixth of the nation’s economy, in the next five days, lawmakers should go back to the bipartisan approach to fixing the Affordable Care Act that began this summer.
The Senate Health, Education, Labor and Pensions Committee, of which Collins is a member, has held hearings on fixes. Earlier this month, for example, Collins questioned state insurance commissioners to get their suggestions for stabilizing the health insurance market.
This is a much better way to address rising premiums and other problems with the Affordable Care Act than a rushed attempt to repeal it, based on political promises, that requires bribes to try to gain support.