Running for president four years ago, Republican Donald Trump promised supporters at a Michigan rally that he would “absolutely terminate and replace Obamacare” with a health care program that would be “a lot less expensive” and provide “much better coverage.”

U.S. Susan Collins, R-Maine, speaks at the recent dedication ceremony at the New Auburn Anniversary Park. Andree Kehn/Sun Journal Buy this Photo

The plan, Trump said, would provide “insurance for everybody.”

That didn’t happen, and health care remains one of the hottest issues on the campaign trail of one of the closest races in American — Maine’s U.S. Senate race. The contest will decide the political fate of Republican U.S. Sen. Susan Collins of Maine and perhaps control of the Senate as well.

The still-controversial Affordable Care Act, which extended coverage to 20 million previously uninsured Americans in a program often known as Obamacare, stands at the center of the debate.

Competing in the Nov. 3 ranked-choice election are Collins, who is seeking a fifth six-year term as one of Maine’s two senators, Democrat Sara Gideon, the Maine House speaker, and independents Lisa Savage and Max Linn.

Each of them has a different take on what the country should do next to bolster its health care system.

The two leading candidates, Collins and Gideon, said they want to improve the ACA, not kill it. One independent contender, Linn, wants to slay Obamacare, while Savage hopes to create a Medicare-For-All system that would make the existing system irrelevant.

Sara Gideon chats with Owen Hiltz, 10 years old, as his father, Jeremy Hiltz listens in Thursday at a men’s recovery house in Auburn. The house is run by Recovery Connections of Maine and Hiltz is the executive director. Andree Kehn/Sun Journal Buy this Photo

None of the four have endorsed Democratic presidential candidate Joe Biden’s health care plan.

Gideon said her plan “shares the same values and the same goals” as Biden’s proposal, but isn’t quite the same thing. Both have an option for the public to buy into Medicare, she said, and both would allow the federal government to negotiate lower prescription drug prices.

Gideon stopped short of endorsing Biden’s call to lower the age of eligibility for Medicare to 60. Instead, she said, “We should simply open up Medicare” for anybody to buy into.

In the first U.S. Senate race debate in Maine, Collins said Gideon’s proposal “would destroy our rural hospitals” by driving up costs.

Collins “believes that we should be focused on strengthening the Medicare program for current and future beneficiaries,” said Annie Clark, her spokeswoman, and wants “to ensure that any changes in the program would not negatively affect people who are current beneficiaries or those who are near age 65.”

Allowing a public option, Clark said, “would lead to even higher prices for patients” than the current system.

Independent U.S. Senate candidate Max Linn of Bar Harbor speaks on a campaign interview show earlier this year. Steve Collins/Sun Journal

Collins has more of a piecemeal approach to the issue that taken together would, in her view, lower the cost of health care without making drastic changes to the system. She’s wary of revisions that haven’t been vetted and endorsed by leaders on both sides of the political aisle.

So far, there’s been little sign of bipartisan consensus to make big changes to Obamacare. But the law could be in trouble anyway because President Donald Trump’s administration has asked the U.S. Supreme Court to nullify it in a case that justices plan to hear next month.

The ACA is in trouble because a tax bill that Collins backed stripped out a mandate in the ACA that everyone have health insurance or pay a penalty. That move may not have hurt the program but could open the door for foes to argue its demise requires the rest of the law to fall as well.

Gideon said the decision the justices render, if they side against Obamacare, could also wipe out protections for preexisting conditions, though Maine law would continue to protect coverage for them. It would also put an end to the Medicaid expansion that Maine approved, she said.

Both independents in the Senate race said they want to see an end to the ACA.

Savage supports a Medicare-for-all approach that would enroll every American into a federal health care system, ensuring everyone would be “able to get medical care when they get sick, with no exceptions.”

Independent candidate Lisa Savage answers a question during a debate in September. Brianna Soukup/Portland Press Herald

“The current market-based system, with 87 million uninsured or underinsured people unable to see a doctor when they need to, is not only immoral, but a public health disaster,” Savage said.

Though a health care program for all would be costly, proponents argue that it would be cheaper than the existing system while providing better care to more people.

Linn doesn’t like health care laws like the ACA, his campaign said, because Obamacare “was written by corporate lobbyists and came with guaranteed profits for the insurance companies.”

It should be replaced with a public/private hybrid form of insurance that makes certain “every American citizen has coverage so that they don’t lose their home or saved assets if they get sick or need treatments, while allowing those who wish to buy extra policies the ability to do so,” Linn’s campaign said.

An end to Obamacare would, no matter what followed, shake up the health care landscape created early in the administration of President Barack Obama.

A decade ago, Collins voted against the Affordable Care Act, Obama’s signature health care program that was pushed through over Republican opposition by Obama and Democratic allies on Capitol Hill.

But Collins wasn’t an ardent foe, even from the start. It wasn’t a given that she would oppose it.

Former U.S. Sen. Mary Landrieu, a Louisiana Democrat, said on the floor of the Senate at the time that Republicans “failed to negotiate in good faith” on the ACA with the exception of Maine’s two senators, Olympia Snowe and Collins.

“I have been in dozens of meetings with both of them and know that they struggled mightily to find a way to work with us and to support this bill,” Landrieu said shortly before the Senate passed it without the support of any GOP senators.

In the end, though, Collins argued that the final proposal offered Americans too few choices and would simply cost too much. She has sometimes expressed the wish that Democrats had kept negotiating the initial bill so that a compromise could have been worked out.

In the years that followed, she voted to repeal the ACA, citing the same concerns she had from the beginning. But each time, she recognized her opposition to the law meant little since a Democratic majority defended the program.

In 2017, after Republicans took control of Congress, an alternative plan passed the House that would have junked the ACA. In a move that drew criticism from many in the GOP, Collins switched sides along with two Republican colleagues to kill the measure in the Senate.

Her decision doomed the GOP proposal, which the Congressional Budget Office had said would leave more than 20 million additional Americans uninsured, and allowed the ACA to survive. Trump at the time called the House measure “mean.”

Though she continued to call the ACA flawed, Collins acknowledged that it “allowed millions of individuals and families to obtain health insurance for the first time” and that it “brought important patient protections like those for people with preexisting conditions and prohibitions on annual and lifetime limits and on insurance payments for needed care.”

What happens next depends on what voters decide Nov. 3.


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