Sen. Susan Collins of Maine said Thursday that she opposes the House Republican health care bill being debated in Congress. Though the moderate Republican previously has raised concerns about the bill to replace the Affordable Care Act, she had not previously said she was against it.

“This is not a bill I could support in its current form,” Collins told the Press Herald in a phone interview. “It really misses the mark.”

Collins explained that nonpartisan sources such as the Congressional Budget Office have estimated that millions would lose coverage. She would prefer a system that improves the ACA and gives more people health insurance. Collins hopes major changes will be made to the bill so she could support it, but it’s not acceptable as is.

“This bill doesn’t come close to achieving the goal of allowing low-income seniors to purchase health insurance,” Collins said. Seniors don’t become eligible for Medicare until age 65. “We don’t want to in any way sacrifice coverage for people who need it the most.”

While adults can purchase ACA insurance regardless of age, the House bill – the American Health Care Act – is increasingly coming under attack for being unaffordable to those 50 and older.

The CBO report released this week said 24 million fewer people would be insured over the next decade under the bill advanced by House Speaker Paul Ryan and supported by President Trump, when compared to the Affordable Care Act. The ACA has reduced the rates of the uninsured since it became law in 2010, and 20 million people nationwide now have ACA insurance, either through the marketplace or Medicaid expansion.

About 80,000 Mainers have ACA insurance, although Maine is one of 19 states that has not expanded Medicaid. The website acasignups.net, which has conducted a state-by-state analysis of the House bill, estimates that 56,000 Mainers who have insurance under the ACA would lose coverage if the Ryan plan was approved.

Collins, as one of a handful of moderates in a chamber closely divided between Republicans and Democrats, is considered a key vote that would determine whether an ACA repeal and replacement could be approved.

Collins hopes behind-the-scenes discussions could end up making the bill more attractive to moderates. However, House conservatives are currently making a strong push to amend the bill that would drive it further to the political right by ending Medicaid expansion more quickly.

At the same time, Democrats and some moderate Republicans are decrying the loss of coverage outlined in the CBO report and lambasting how much more expensive insurance would be for older and working-class Americans.

The Ryan bill does not adjust for geography or for income – except for higher incomes – so a 60-year-old living in Portland or Caribou would receive $4,000 to help pay for a health plan regardless of whether the enrollee earns $20,000 or $50,000.

The $4,000 doesn’t come close to paying for a health plan for those who are in their 50s or early 60s, according to CBO estimates.

Also, health care costs can vary widely by region and are typically much more expensive in rural areas. For instance, a silver plan for a 60-year-old who earns $30,000 purchased on the ACA marketplace would currently cost $8,692 in Portland, but $13,317 in Caribou, according to the Kaiser Family Foundation.

Under the ACA, premium tax credits make up for geographical differences, so a person earning $30,000 per year would pay about $200 in monthly premiums regardless of where the enrollee lived.

In contrast, under the Ryan bill, the geographical price disparities would be shouldered by enrollees, so that same 60-year-old living in Caribou would pay hundreds more per month in premiums compared to a Portland resident.

Those disparities are unacceptable, Collins said.

“Older people living in rural America would be really left behind,” Collins said.

“This bill would have a devastating impact on older Mainers,” said Lori Parham, state director of AARP Maine. “If you’re over 50, you would have it really tough.”

Collins’ objections to the House Republican bill were cheered by Maine health advocates.

“I’m not surprised, but glad to hear Sen. Collins is unequivocally against these kinds of changes for Maine,” said Emily Brostek, executive director of Consumers for Affordable Health Care, an Augusta-based health advocacy group.

Rep. Chellie Pingree of Maine, D-1st District, said the House bill would be much worse for older, sicker Americans.

“It’s terrible policy. There’s no good argument for this bill,” she said.

Pingree said House Republicans are “just trying to jam it through” without considering the negative consequences.

Sen. Angus King of Maine, an independent who caucuses with the Democrats, held a discussion about the ACA at People Plus nonprofit in Brunswick, and he said the Ryan plan forces people to “reach deeper into their pocket to pay for health insurance.”

“And meanwhile, higher-income people get a tax break,” King said, referring to how the Ryan plan repeals Obamacare taxes that currently fall on the wealthy. “It’s a classic shift and shaft – and for a lot of older people in Maine, it means they’re not going to be able to afford health insurance anymore, have to go without, and hope they don’t get sick,” King said in a statement. “This bill is going to do more harm than good, and I urge my colleagues to work together to make meaningful improvements to the Affordable Care Act, not abandon it altogether.”

Collins and Sen. Bill Cassidy, R-La., introduced an ACA replacement bill in January that is substantially to the left of the Ryan bill. It would allow states to keep the ACA or choose an option under Collins-Cassidy that would provide tax credits that are more generous than those in the Ryan plan.

Although the Cassidy-Collins plan hasn’t received much national media attention, Collins said she has had some behind-the-scenes discussions with “several Democrats” that could prove fruitful. Collins wouldn’t disclose the names of the Democratic senators who might be willing to support her bill.

Brian Duff, a political science professor at the University of New England, said Collins could no longer stay on the sidelines about the Ryan bill, which has been attacked by numerous groups, including hospitals, doctors, the AARP and health advocacy groups.

“Being vague was not winning her any points,” Duff said. “I know she was getting a ton of calls. It was time for her to cut ties and disassociate herself with a bill that was so unpopular.”

Jim Melcher, a political science professor at the University of Maine Farmington, said Collins’ vote can be unpredictable, and the fact that she’s one of the few Senate Republican moderates means her vote is sought after by Democrats and Republicans.

For her to come out so quickly against the Ryan plan means the bill would likely have difficulty passing the Senate. Only three Republicans need to vote “no” for the Ryan bill to fail.

“Those are unusually strong statements for her to make,” Melcher said.

Collins hopes Congress slows down and tries to devise a solution that improves the Affordable Care Act.

“This is so complex. It’s important we do this right,” she said.

Joe Lawlor can be reached at 791-6376 or at:

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