As tax reform debate proceeds in the Senate, all eyes are, once again, on Sen. Susan Collins (R-Maine) in a Senate majority with few votes to spare.
Collins, after all, was a profile in courage in defeating prior attempts to repeal, and replace, the Affordable Care Act. She did so not out of support for the ACA, which she has opposed, but because of the overreaching nature of bills like the Better Care Reconciliation Act (BCRA) and Graham-Cassidy. Both would have eviscerated Medicaid along with further destabilizing health insurance markets.
{mosads}As Collins noted during debate over the BCRA, its cuts to traditional Medicaid would “jeopardize the very existence of our rural hospitals and our nursing homes.” Her principled position drew a great deal of censure from fellow Republicans, including Maine Gov. Paul LePage, who even called her “downright dangerous” in a blistering Wall Street Journal column. This foment within her own party, making an open primary risky, contributed to Collins’ decision to not run for governor to succeed LePage.
Threats to Medicaid from congressional Republicans have only made it more popular. Since the Senate debate over the BCRA, a Medicaid expansion proposal designed to circumvent LePage drew support from almost three-fifths of Maine voters.
Further, as Collins had noted during BCRA consideration, Medicaid “has been a safety net program on the books for more than 50 years ensuring that some of our most vulnerable citizens or disabled children or low-income seniors receive the health care that they need.” Kaiser Family Foundation polling found that even Republicans support traditional Medicaid. Only 22 percent of Republicans wanted to decrease Medicaid spending, while a recent poll found only 36 percent of voters overall support the Republican efforts to cut taxes.
In light of all of this, why would Collins now vote for a Senate tax scheme predicated upon cutting both Medicaid and Medicare? Older voters were key to President Trump’s Electoral College victory, with one exit poll analysis showing him winning voters 65-and-older by a 53 percent to 45 percent margin.
Would these voters — many of whom are retired and wouldn’t benefit from tax cuts directed largely to wealthy income-earners — want a $473 million Medicare cut, or over one trillion dollars in cuts to Medicaid, the payer for most nursing home residents as well as those in home-and-community-based settings?
Such cuts will be but the tip of the iceberg, given the unrealistically revenue growth assumptions behind the Republican tax plan. Maine, it’s worth noting, has the nation’s oldest population by median age, as Sen. Collins is surely aware.
Collins should also keep in mind that a tax plan that disproportionately burdens lower-income citizens is, paradoxically, more likely to drive them someday into Medicaid.
Congressional Budget Office analysis shows that households making less than $75,000 a year will, ultimately, pay more taxes under the Senate Republican plan. The most recent survey found that the median household income in Maine is $53,079. If the Senate Republican tax proposal actually makes those households poorer, while cutting the safety net for them that Collins has previously defended, it’s best to walk away from it no matter what modest concessions you might obtain.
It would be a shame for Collins to have endured such opprobrium in winning key battles, acting on the moral imperative to protect her constituents, only to surrender in the ongoing congressional war upon seniors and those with disabilities.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association, which represents 90 long-term care facilities. Williams is also an attorney, former Washington state deputy insurance commissioner and former Washington state representative.