Senator Susan Collins, Republican of Maine, has spent a lot of time thinking about how to deal with these “subsidy cliffs,” even as her party’s leaders press for the wholesale repeal of the Affordable Care Act, President Barack Obama’s signature domestic achievement.
As she and a handful of other Republican senators think about repairs rather than replacements, discussions that will intensify this week after the Memorial Day break, they are frustrating the grander ambitions of the Senate majority leader, Mitch McConnell of Kentucky — not to mention President Trump — to unravel the law as the House did last month.
Ms. Collins’s résumé (she once oversaw Maine’s insurance bureau), her relentless practicality and her state’s particular vulnerability within the health care debate — its population is old and largely poor, with a sizable part-time work force — have placed her at the center of an issue that conservatives have tried to dominate in Congress.
“There is no denying that the Affordable Care Act has made insurance available to millions of Americans and allowed people to leave corporate jobs and start businesses,” Ms. Collins said. “We are disproportionately affected, which is one reason I’ve spent so much energy on this issue.”
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Maine has been viewed by Republicans as a possible model for some reforms. It was one of a handful of states that embraced a “guaranteed issue” policy of health insurance, regardless of pre-existing medical conditions, and it created “invisible” high-risk pools to help sick people buy insurance and stabilize the markets.
Republicans cite Maine as the model for the risk pool in the House measure, but Ms. Collins notes that the House bill does not fund state-based risk pools anywhere near the level that Maine has.
“One of the problems with the exchanges is that the pools are not large enough,” she said. “It would cost $15 billion annually to expand nationally a patient stability fund like Maine did.”
