Maine’s Susan Collins was a health care hero, but now advocates are branding her a villain

Sen. Susan Collins, R-Maine, and other senators rush to the chamber to vote on amendments as the Republican leadership works to craft their sweeping tax bill in Washington.Associated Press/J. Scott Applewhite, File

WASHINGTON — Susan Collins received a hero’s welcome in Maine this summer after she stymied efforts by her fellow Senate Republicans to repeal the Affordable Care Act. Crowds applauded her at the airport. Activists brought her flowers and thank-you cards.

Less than six months later, protesters returned to the Bangor airport, hoping to greet her with signs declaring “Shame.” Collins didn’t show up. She remained in Washington last week after voting to support the Senate’s tax cuts, dashing hopes among Democrats and activists that she would defy GOP leadership once again.

It has been a dizzying turnaround for the popular moderate, the only Senate Republican left from New England.

What dismayed health care advocates is part of the tax-cut legislation that wipes out a fundamental element of the federal health care law: the “individual mandate,’’ which requires that all Americans either purchase insurance or pay a tax penalty.

“We’re disappointed. Everyone’s disappointed,” said Marie Follayttar Smith, a cofounder of Mainers for Accountable Leadership, a liberal grass-roots group that has organized several protests in the past week aimed at pressuring Collins to change her position on the tax bill.

In an interview, Collins said she is puzzled by the strength of the outcry against her vote — though as a centrist she’s used to attracting arrows from both the left and the right.

Responding to those who accuse her of betraying her previous health care positions, Collins said, “That’s just not accurate.”

She pointed to hard-won promises she extracted from Republican leaders to pass separate legislation that aims to strengthen the health care law’s individual health insurance marketplaces and mitigate premium increases that will result from abandoning the individual mandate.

“What I’m trying to do is solve the biggest problem that we have, and that is the unaffordability of health insurance and the high deductibles that make it virtually useless for many people who make just a little too much money to qualify for subsidies under the Affordable Care Act,” Collins said.

But her critics say Collins got played by accepting those promises. Conservatives in the House are openly balking at voting for the two bipartisan health care bills Senate majority leader Mitch McConnell pledged would be adopted by the full Congress by the end of the year. News reports this week revealed that House Speaker Paul Ryan told congressional staff after the Senate vote that he was not a party to McConnell’s promise to pass the provisions that Collins demanded.

“She made a political error that’s going to cost Mainers and cost people across the country basic lifelines while [helping] the wealthy,” said Smith, the Maine activist.

Save My Care, a liberal group supporting the Obama-era health law, has made concerns over those promises a centerpiece of its latest TV ad in Maine, part of a six-figure campaign launched to pressure Collins to change her position on the tax bill.

“Senator Collins said Republican leaders promised her they would fix things,” the narrator intones, while headlines about resistance in the House to her bills flash on the screen. “Now we know they lied to her and Mainers will suffer the consequences.”

Collins, who isn’t up for reelection until 2020, is not wavering. She remains confident she’ll get what she was promised and is clearly frustrated by the steady drumbeat of doubt.

“I don’t know whether there’s a group on the far left that’s just rooting for me to fail or what’s going on here, but I have had meeting after meeting [and] put in writing the commitment from the Senate majority leader, and I believe this will happen,” Collins said.

She said she had three meetings with President Trump and his team in which he promised support for those bills, “and the president has a lot of influence on those conservative House Republicans.”

She also spoke Tuesday night with Ryan, who has not said he opposes the two bills that Collins hopes would ease the pain of the individual mandate repeal.

Collins said her critics ignore that she’s also received pledges from McConnell and Ryan not to allow $25 billion in automatic cuts to Medicare to take effect, which are required by current budget rules unless Congress acts to waive them.

Collins also said that she has not been inconsistent. She said she has long supported repealing the individual mandate, even if she thought doing so in the tax bill was the wrong tactic. She said that 80 percent of the people who pay tax penalties for not adhering to the mandate and failing to buy insurance are middle- and low-income families, making less than $50,000 a year.

The first of the two bills Collins was promised by McConnell would provide subsidies to insurance companies that sell policies on the ACA’s state-by-state exchanges. The other, which Collins cowrote with a Democrat, Senator Bill Nelson of Florida, would give states several billion dollars over two years to help cover costs for the sickest patients. One study from the private sector has said the bills could lower premiums by 18 percent in 2019 and boost insurance enrollment by 1.3 million.

But the damage from repealing the individual mandate is estimated to be far greater than those fixes could repair. The nonpartisan Congressional Budget Office said last month that repealing the individual mandate would leave 13 million fewer people covered by health insurance in 10 years. And premiums would jump by an additional 10 percent a year above already-expected increases, the CBO said.

In Maine, about 50,000 fewer people would have health insurance by 2027, according to the Maine Center for Economic Policy.

Even if the promised Collins legislation is passed, “it’s not enough money to solve a problem that they’re creating” by repealing the mandate, said Steve Butterfield, policy director with the Augusta-based Maine Consumers for Affordable Health Care.

“From our perspective there’s a really easy way to fix this — don’t break it in the first place. . . . Don’t destabilize and destroy the individual market and coverage for 13 million people nationally,” he said.

But other health care advocates say Collins remains far from the villain.

Among other changes she negotiated to the Senate tax bill, she reduced the threshold for deducting taxes for medical expenses; the House bill eliminates medical expense deductions altogether.

“We very much appreciate Senator Collins’s continued willingness to do what she can to fight in the health care space,” said Jeffrey Austin, vice president for government affairs for the Maine Hospital Association. “She has done it all year, and we think some of the criticisms of her in this latest issue have been unfair. She is one senator out of 100 and she is almost single-handedly taking on the issue of fighting for health care and using the leverage that she has.”