When Congress reconvenes after Labor Day, Maine Sen. Susan Collins will be at the center of efforts to improve the Affordable Care Act.

Whether Congress is finally in the mood for health care compromise is uncertain, as President Trump has continued to chastise Republican leadership for failing to repeal Obamacare. At the same time, a key Senate committee that Collins sits on will be working on compromise plans.

Collins – in one of the most dramatic votes of her career – was one of three Republicans to vote “no” and stop a bill to repeal and replace the Affordable Care Act. Collins and Sens. Lisa Murkowski and John McCain broke party ranks and cast the deciding votes in the early morning hours on July 27, votes that prevented millions from losing health insurance over the next decade.

Collins, in an interview Friday with the Press Herald at her Portland office, said that she has been tapped by Sen. Lamar Alexander, R-Tenn., who is chairman of the Health, Education, Labor and Pensions Committee, to work on health care solutions. Alexander and Sen. Patty Murray, D-Wash., the committee’s ranking member, are trying to formulate a bipartisan compromise.

Collins, a member of the committee, said Alexander pulled her aside before senators left for the August recess and told her that she would play a “central role” in crafting legislation that could appeal to Democrats and Republicans.

About 20 million Americans have insurance through the Affordable Care Act, and the uninsured rate has dropped since it went into effect, but even ACA advocates acknowledge there are flaws in Obamacare that need to be fixed.

“I will be very active,” Collins said. “This is what we should have done in the first place. Bring in the experts, bring in the witnesses and let’s figure this out.”

The various repeal bills that were considered in the House and Senate were hammered out in secret and did not go through the committee process. Many Republicans criticized the process, but in the end Collins, Murkowski and McCain were the only Republicans to vote “no.”

On Sept. 6 and 7, Alexander’s committee will hear testimony from state insurance commissioners and Republican and Democratic governors, including Gov. Charlie Baker, R-Mass., and Gov. Steve Bullock, D-Mont., about how to improve the ACA.

Collins said since the “hyperpartisan” process appears to have failed, perhaps now solutions can be found.

“Now that we’re past this gridlock, people are coming to the table with real ideas,” Collins said in her eighth-floor Portland office, which has sweeping views of the city’s waterfront.

Collins said that during the tumultuous week before the final ACA repeal vote, she hosted the first of three private bipartisan meetings where the two sides could start talking to each other and learn how to work together in case ACA repeal failed.

“We had 10 to 12 senators, Democrats and Republicans, in an ‘off the record’ dinner. We discussed whether we could see a path ahead if all the bills failed,” Collins said.

Collins said she’s also discussed health policy with the House Problem Solvers caucus, a bipartisan group of House members who have proposed the outlines of a compromise.

Many ideas and proposals have been floated, including shoring up the ACA’s individual market while at the same time easing Obamacare mandates for smaller companies. Alexander’s committee is also due to consider a law requiring the executive branch to fund cost-sharing reductions, which are additional subsidies for low-income families to purchase ACA insurance. Trump has threatened not to fund the cost-sharing subsidies. While people who qualify would still be entitled to the subsidies regardless of whether the executive branch funds them, if the Trump administration pulls the money away it could cause financial problems for the health insurance industry, and premium increases to make up for the lost subsidies.

About 80,000 Mainers have ACA marketplace insurance. Under the ACA, the national uninsured rate has declined from about 17 percent in 2013 to 10.9 percent in 2016, according to Gallup polling.

Collins, 64, said her time in the late 1980s and early 1990s as commissioner of the Maine Department of Professional and Financial Regulation – which includes the Bureau of Insurance – has helped shape her views on health care, and she leaned on that knowledge during the ACA repeal debate.

Shortly after she started as commissioner, the workers’ compensation markets collapsed. So she didn’t want Congress to cause health insurance markets to collapse in the way it repealed the ACA.

“I’ve seen what happens when insurance markets collapse. I had to do a crash course in the late 1980s on insurance,” Collins said.

Collins said in the 1980s and 1990s she also worked on state health care reform, coming up with rules to make health care affordable for small companies to offer to their employees.

She said she believes most employers want to provide health care coverage because they care about their employees and it helps with job retention and attracting workers, but most small employers can’t afford it.

“Our goal was always to expand access to insurance. That was always our goal. And it still is my goal,” Collins said.

Collins said the vote on July 27 was suspenseful – and a “dramatic and significant moment.” The vote was in alphabetical order, so she was the first Republican to vote “no.”

“I was cognizant of the fact I would be the first Republican to cast my vote against the bills,” Collins said. “It’s hard to think that your team is making the wrong decision, but in the end you’ve got to be able to look in the mirror and feel you did the right thing.”

Brent Andersen, an adjunct assistant professor of political science at the University of Maine at Presque Isle, said Collins’ vote was a moment in history.

“It was extremely rare. For moderate Republicans to torpedo a major piece of legislation is a milestone. It’s a defining moment in her career,” Andersen said.

Collins has been mulling a run for governor in 2018, and she has said she expects to decide this fall. Andersen said the health care vote could be a major issue in the Republican primary if Collins were to run. Republican Gov. Paul LePage has criticized Collins for her ACA repeal vote.

Dr. Dora Anne Mills, vice president of clinical affairs at the University of New England and former director of the Maine Center for Disease Control and Prevention, said the vote was important, but many chapters have yet to be written.

“The ACA story and her ongoing role in it is unfinished,” Mills said. “On the one hand, it could be recorded as her Margaret Chase Smith moment. Or it could be a comma in a yet-to-be-finished lengthy paragraph.”

People waiting to board planes spontaneously applauded Collins when she arrived at Bangor International Airport the day after the vote. And Collins said people have been coming up to her and praising her ever since, at community events, chamber of commerce and Rotary Club dinners.

“In general, there has been incredible, overwhelming support. That has been really nice to hear,” Collins said.

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

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