Clockwise from left: Lisa Savage, Susan Collins, Max Linn and Sara Gideon. Credit: Composite photo

Health care was already a top issue for voters in Maine and across the country prior to the coronavirus pandemic, which has highlighted concerns over employer-provided insurance and high prescription drug prices as the state prepares to decide a major U.S. Senate race.

The last major piece of health care legislation, the Affordable Care Act, passed along party lines in 2010. The law increased health care coverage, primarily through the expansion of Medicaid which rolled out in Maine last year after years of political wrangling over the topic in Augusta.

Republicans attempted to repeal the law after taking over both chambers of Congress and the presidency in 2017, but failed when U.S. Sen. Susan Collins and two other Republican colleagues opposed the bids. The law, however, is still in jeopardy because of a 2017 Republican tax bill. The Supreme Court will hear a landmark case on that after the election.

Collins and her opponents in the 2020 election — House Speaker Sara Gideon, D-Freeport, and independents Max Linn of Bar Harbor and Lisa Savage of Solon — agree on lowering drug prices, but deeply differ on how to expand coverage.

Here is more on where they stand on the topic of health care, which you told us was the policy area of highest importance in the election when we surveyed readers on that earlier this summer as part of our “citizen’s agenda” model of political coverage.

READ MORE ON THE 2020 SENATE RACE

Susan Collins

Collins has a mixed record on the health care law — she initially opposed it and voted repeatedly to repeal it, but sided with Democrats to block its repeal in 2017. She later voted for her party’s tax bill that is the basis for the lawsuit against the law, though she has decried that challenge. She also backed a form of Medicaid expansion in Maine three years ago before voters approved it and as the administration of then-Gov. Paul LePage resisted expansion.

The Maine senator has also worked extensively on prescription drug legislation, something she has highlighted often. Her record includes a 2019 bill she co-sponsored which aims to increase access to generic drugs and a 2018 bill prohibiting so-called “gag clauses” preventing pharmacists from telling consumers when it would be cheaper to pay for a drug out-of-pocket.

To increase health insurance access, Collins co-sponsored two bills that would have lowered premiums and expanded coverage to about 3.2 million people, according to one analysis, through a program reimbursing insurers for seriously ill patients and bringing down costs for others. Collins initially indicated her tax vote came after assurances that Republicans would advance that measure, though she later said it was not contingent when it did not move forward.

Sara Gideon

Gideon, the Democratic nominee, talks about health care often on the campaign trail. Broadly speaking, she supports a Medicare-like public option for individuals to buy government health insurance, but would not do away with private health insurance.

Her proposal is similar to that put forward by former Vice President Joe Biden, the Democratic presidential nominee, and has some chance of passing if Democrats take control of the Senate and the presidency. The nonpartisan Committee for a Responsible Budget predicted it would increase the national deficit by $800 billion over 10 years, though its estimates showed a wide range of uncertainty.

Gideon rolled out a health care plan in August that addressed common criticisms of the public option, including concerns that Medicare’s low reimbursement rates would threaten rural hospitals that already face financial struggles. She calls for more hospitals to be designated as “critical access,” which would allow them to be reimbursed for procedures at just above cost.

As a legislator, Gideon worked on health care issues, including co-sponsoring bills in recent years to codify parts of the Affordable Care Act into Maine law, allow more medical providers to perform abortions and cap the cost of insulin for individuals with private insurance. She also co-sponsored a 2014 single-payer health insurance bill that was turned into a proposed study, though it went nowhere after a veto from then-Gov. Paul LePage.

Lisa Savage

Savage, a former Green Party member running in the Senate race as an unenrolled candidate, is the only one in the field backing Medicare for All, the kind of health care program championed by Sen. Bernie Sanders, I-Vermont, that would replace private health insurance with a single payer system.

Proponents of Medicare for All argue it would be more cost-effective and would ensure universal coverage, while opponents argue it would be too expensive and displace coverage for individuals who like their private insurance. Sanders acknowledged that his plan would likely cost more than $30 trillion over a decade, though he argued this was cheaper than private insurance coverage over the same period.

Savage cites a study published in The Lancet, which argues that a single-payer system would save 68,000 lives and $450 billion each year over the current system. The estimate is based on predictions about the elimination of some costs, such as executive salaries, and reduced emergency room visits due to better primary care. Access to primary care also accounts for the lower mortality rate. Fact-checkers have generally been skeptical of the Lancet study, though.

Medicare for All still seems a distant reality in Washington, with Democrats unlikely to have enough votes to pass it even if they win a majority in the Senate. The idea remains more popular among the public, with 56 percent of voters saying they somewhat or strongly support Medicare for All in a Kaiser Family Foundation poll earlier this year.

Max Linn

Linn, a retired financial planner from Bar Harbor, said he does not support Medicare for All but would support a public system that would provide some level of basic coverage and allow individuals to buy supplemental private insurance. He has described himself as a pro-Trump conservative and is running on a mix of policies from the left and right, and said he supports the president’s efforts to lower prescription drug costs.

Trump, a Republican, has signed several bills addressing prescription drug prices during his presidency, including the legislation Collins co-sponsored on generics and gag clauses. Last winter, he also proposed a rule change that would ease the importation of some prescriptions from Canada.

More recently, Trump issued several executive actions on prescription drug prices, though the regulatory changes needed to implement those orders are still in the works, so individuals are unlikely to see any effect this year.