U.S. Sen. Susan Collins, R-Maine, said Wednesday that she hasn’t given up on fixes to the Affordable Care Act’s individual marketplace, despite such efforts failing in Congress last month. But she’s “not very optimistic” that the measures will be taken up this year.

Collins made an appearance Wednesday at The Barbara Bush Children’s Hospital at Maine Medical Center in Portland to receive an Excellence in Public Service award from the American Academy of Pediatrics, in part for her vote last summer against repealing the ACA. Collins was one of three Republicans to buck the party on the ACA repeal, and it failed by one vote.

“I believe we have to do the ACA fixes or else the individual markets will collapse in some states,” Collins said. “Inevitably, we’re going to have to do something to shore up the individual market.”

About 75,000 Mainers and 20 million Americans have had ACA insurance, either through the health insurance marketplace or Medicaid expansion. Maine voters approved Medicaid expansion in November, but it has yet to be implemented.

Collins said one danger of not making the reforms is that insurers could stop offering coverage in rural counties, leaving some without ACA individual insurance. In rural areas, health care is expensive for a number of reasons, including long distances traveled to health care services and lack of competition among health care providers.

Collins said in December that she would support the controversial, Republican-led $1.5 trillion tax cut bill in exchange for promises by Republican leaders that the ACA stabilization measures she had lobbied for – including $30 billion in reinsurance and restoring payments to insurance companies that had been taken away by the Trump administration – would be approved. The ACA measures were originally supposed to be approved by the end of 2017, but the deadlines slipped and the effort collapsed last month when Congress approved an omnibus spending bill without including the measures.

Collins said Wednesday the process had become “poisoned” by partisanship. Fights between Democrats and Republicans over provisions limiting payments for abortions and how effective the stabilization measures would be deep-sixed the stabilization efforts led by Collins and Tennessee Republican Sen. Lamar Alexander. U.S. Sen. Patty Murray, D-Washington, walked away from the deal after the abortion fight.

States can enact their own reforms to help ease cost pressures on premiums and deductibles, such as state-run reinsurance.

For instance, Maine is launching a $90 million reinsurance program – to be funded with a blend of federal and state tax dollars plus fees on insurance plans – that will help keep premiums in check for 2019. Reinsurance will keep premiums about 10 percent lower than they otherwise would be, according to an independent analysis of the Maine reinsurance system likely to go into effect next year. Insurers will file rates later this spring for 2019.

Meanwhile, congressional midterm elections are looming this fall, with Democrats having a chance to retake the House. Collins said it’s difficult to predict how the elections might affect legislation that aims to improve the ACA.

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

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