133-609: HCFA may refer to: American Health Care Act of 2017 , also known as the Health Care Freedom Act Centers for Medicare and Medicaid Services , formerly known as the Health Care Financing Administration Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with the title HCFA . If an internal link led you here, you may wish to change
266-577: A 5% GDP difference represents about $ 1 trillion or $ 3,000 per person. Some of the many reasons cited for the cost differential with other countries include: Higher administrative costs of a private system with multiple payment processes; higher costs for the same products and services; more expensive volume/mix of services with higher usage of more expensive specialists; aggressive treatment of very sick elderly versus palliative care; less use of government intervention in pricing; and higher income levels driving greater demand for health care. Healthcare costs are
399-469: A May 1997 interview, Collins stated her support for a proposal by Tom Daschle banning all abortions after the fetus is capable of living outside the womb except to save the life of the woman or protect her from physical injury. Of an alternative measure proposed by Rick Santorum that would ban partial-birth abortion, Collins said it "ignores cases in the medical literature involving women with very serious physical health problems". In 2001 Collins authored
532-463: A decisive margin. In 2009, Collins was called one of "the last survivors of a once common species of moderate Northeastern Republican". She is considered a centrist Republican and an influential player in the Senate. Although she shared a centrist ideology with Maine's former senator, Olympia Snowe , Collins is considered a "half-turn more conservative" than Snowe. She was consistently endorsed by
665-747: A decorated veteran of World War II , also served in the Maine Legislature , with one term in the House, and four in the Senate. Collins's mother was born in Barrancabermeja , Colombia , to American parents. Collins is of English and Irish ancestry. Her uncle, Samuel W. Collins Jr. , sat on the Maine Supreme Judicial Court from 1988 to 1994 and served in the Maine Senate from 1973 to 1984. Collins attended Caribou High School , where she
798-521: A deputy state treasurer in the office of the Treasurer and Receiver-General of Massachusetts in 1993. After moving back to Maine in 1994, she became the Republican nominee for governor of Maine in the 1994 general election . She was the first female major-party nominee for the post, finishing third in a four-way race with 23% of the vote. After her bid for governor in 1994, she became the founding director of
931-485: A fundamental driver of health insurance costs, which leads to coverage affordability challenges for millions of families. There is ongoing debate whether the current law (ACA/Obamacare) and the Republican alternatives (AHCA and BCRA) do enough to address the cost challenge. Both the Republican House AHCA and Senate BCRA bills have proposed major reforms relative to current law (ACA) that would substantially reduce
1064-531: A joint letter. Conservative groups, including Heritage Action , the Cato Institute , Americans for Prosperity , FreedomWorks , and Tea Party Patriots all oppose the bill. Progressive groups, including MoveOn.org , American Bridge , the Center for American Progress , and Our Revolution , were resolutely opposed to the bill, as expected. Economist and The New York Times columnist Paul Krugman stated that
1197-567: A letter asking that the vote be postponed to allow public hearings on the merits of repealing net neutrality. They expressed concerns that repealing net neutrality could adversely affect the U.S. economy. As part of this drive, Collins is reported to support using the authority under the Congressional Review Act to nullify the FCC's repeal vote. In 2018, Collins was one of three Republicans voting with Democrats to repeal rule changes enacted by
1330-656: A measure that granted the United States Secretary of Education authority to grant waivers that would relieve reservists and members of the National Guard from making federal student loan payments during active duty and grant the same privileges to victims and families of those affected by the September 11 attacks . The bill passed the Senate and House in December 2001. In November 2002, the Senate overwhelmingly approved
1463-538: A motion that would have allowed the Senate to vote separately on the charges and the sentence. The motion failed, and Snowe and Collins voted to acquit, believing that while Clinton had committed perjury , that was not grounds for removal from office. In March 1997, the Senate adopted a broader investigation into White House and Congressional campaign fund-raising practices than Senate Republicans initially wanted. Collins said there were "a number of allegations that may or may not be illegal, but they may be improper." In
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#17328580948821596-550: A repeal bill without hearing from consumers, health care providers, insurance companies or state officials – and without having estimates of the cost or the impact on coverage from the Congressional Budget Office". In House committees, Democratic representatives offered more than 100 amendments to the legislation, including amendments that "would have required the law to guarantee no one would lose insurance, hospitals would not see an increase in uncompensated care,
1729-466: A repeal, calling it "Obamacare 2.0". The Koch brother-supported organizations Americans for Prosperity and Freedom Partners have indicated their intention to put together a multimillion-dollar fund in support of re-election campaigns for conservative lawmakers who take a stand against the bill. The AARP released a statement opposing the bill. Stating, "On top of the hefty premium increase for consumers, big drug companies and other special interests get
1862-523: A statement in the Congressional Record stating he or she had read the bill." All of these Democratic amendments were rejected, as Brady (the chairman of the House Ways and Means Committee ) ruled that the amendments were "not germane" to the bill, and the Republican majority repeatedly upheld these rulings. In the days leading up to the vote, which was originally scheduled for March 23, 2017, there
1995-561: A subpoena seeking documents and interviews associated with the American government's investigation into the conduct of investigators during their interactions with Nidal Hasan before the Fort Hood shooting . The Pentagon announced that the Obama administration would not authorize Senate investigators to question intelligence agents who reviewed e-mails between Hasan and an extremist Islamic cleric before
2128-474: A sweetheart deal". The American Medical Association released a statement opposing the bill. America's Essential Hospitals , American Hospital Association , Association of American Medical Colleges , Catholic Health Association of the United States , Children's Hospital Association , Federation of American Hospitals , and National Association of Psychiatric Health Systems also stated their opposition in
2261-450: A very climactic moment, he gave a thumbs down and the bill was rejected 49–51, with two other Republican senators, Susan Collins and Lisa Murkowski , siding with all Democrats and Independents. On September 13, 2017, Senators Graham , Cassidy , Heller , and Johnson released a draft amendment to the bill that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states". However, it
2394-675: A vote by the full Senate; and two others, Henry Saad and William Myers , were expressly denied such protection (both eventually withdrew their names from consideration). In October 2008, Collins criticized robocalls by the McCain campaign claiming that Barack Obama "has worked closely with domestic terrorist Bill Ayers , whose organization bombed the U.S. Capitol, the Pentagon, a judge's home and killed Americans", asserting that those "kind of tactics have no place in Maine politics" and urging McCain to cease
2527-438: A vote of 12–11 to allow the full Senate to vote. Collins justified her vote, saying, "Presidents are entitled to considerable deference in the selection of Cabinet members." Later, she and Murkowski were the only Republicans to break party lines and vote against DeVos's confirmation. This caused a 50–50 tie that was broken by Senate President Mike Pence to confirm DeVos. In March 2017, Collins said she could not support
2660-565: Is changing insurers will not pay a higher rate with their new insurer. Individuals who wished to buy insurance but were outside of the coverage gap would have paid a 30 percent premium surcharge for one year and then return to standard rates. Both healthy and the sick were required to pay the surcharge, which may have caused healthier persons to remain outside of the market, causing overall health care costs to rise (see adverse selection , high-risk pool ). In general, CBO has been more accurate than other significant forecasting entities regarding
2793-469: Is expected to cover). Other groups have evaluated some of these elements, as well as the distributional impact of the tax changes by income level and impact on job creation. The results of these analyses are as follows: According to each of the CBO scores, passage of the Republican bills would result in a dramatic reduction in the number of persons with health insurance, relative to current law. CBO has evaluated
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#17328580948822926-543: Is steeply progressive, with the top 1% paying 90% of the tax, as investment income is highly concentrated with the wealthy. The ACA also established a penalty tax (related to the individual mandate) for individuals without adequate insurance, an excise tax on employers with 50 or more workers who offer insufficient coverage, annual fees on health insurance providers, and the "Cadillac tax" (yet to be implemented as of 2017) on generous employer-sponsored health plans. Combined with subsidies that primarily benefit low-income households,
3059-631: Is the primary payer of nursing home care. The ACA (current law) expanded Medicaid eligibility; 31 states and the District of Columbia implemented the expansion. Approximately 41% of Medicaid enrollees are white, 25% are Hispanic, and 22% are black. The proportion of white recipients in key swing states are 67% in Ohio, 59% in Michigan, and 58% in Pennsylvania. About 48% of recipients are children (18 or under). Most of
3192-712: The AHCA or nicknamed Ryancare ) was a bill in the 115th United States Congress . The bill, which was passed by the United States House of Representatives but not by the United States Senate , would have partially repealed the Affordable Care Act (ACA). Republican Party leaders had campaigned on the repeal of the ACA since its passage in 2010, and the 2016 elections gave Republicans unified control of Congress and
3325-608: The American Health Care Act , the House Republicans' plan to repeal and replace the Affordable Care Act . She announced she would vote against the Senate version of the Republican bill to repeal Obamacare. Collins also clarified that she opposed repealing the ACA without a replacement proposal. On July 26, Collins was one of seven Republicans in voting against repealing the ACA without a suitable replacement. On July 27, she joined two other Republicans in voting against
3458-645: The American Medical Association and the American Academy of Pediatrics , strongly condemned the bill and excoriated its supporters in Congress. The ACA (colloquially called "Obamacare"), a major reform of health care in the United States , was passed in 2010 by the 111th Congress and signed by President Barack Obama in 2010 after nearly a year of bipartisan debate. The ACA draws from many conservative ideas proposed by The Heritage Foundation in
3591-513: The Human Rights Campaign , a major LGBT rights organization, until 2020. She supported John McCain in the 2008 presidential election . She became the state's senior senator in 2013 when Snowe left the Senate and was replaced by independent Angus King , who defeated Collins in the 1994 governor election . In the 1990s, Collins played an important role during the Senate's impeachment trial of Bill Clinton when she and Snowe sponsored
3724-602: The Libertarian Party 's ticket or a write-in candidate . In the 2016 United States presidential election , Collins received one electoral vote for vice president from a faithless elector in Washington. In January 2017, Collins and Senator Lisa Murkowski voted for Trump's nominee for Secretary of Education, Betsy DeVos , within the Senate Health, Education, Labor and Pensions Committee, passing DeVos's nomination by
3857-535: The Office of Management and Budget , to convince members of the House Freedom Caucus to support the legislation. According to numerous reports, Mulvaney was unsuccessful. Shortly after the meeting caucus chairman Mark Meadows said, "No new position tonight. Our position is the same. We believe we need to do a clean repeal bill." A number of conservative groups have also criticized the bill for not being enough of
3990-457: The Rules Committee , which sets the terms of the debate before a bill comes to the full House. A House vote was initially scheduled for March 23, but was delayed for at least a day after Republican leaders were unable to find enough votes for passage. On March 24, with both moderate and far-right Republican lawmakers opposing the bill, Speaker Paul Ryan and President Trump chose to withdraw
4123-508: The Small Business Administration in 1992. After briefly serving in this post until the 1992 election of President Bill Clinton , she moved to Massachusetts and became Deputy State Treasurer of Massachusetts under Joe Malone in 1993. Returning to Maine, Collins won an eight-way Republican primary in the 1994 gubernatorial election , becoming the first woman nominated by a major party for governor of Maine . During
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4256-526: The Tax Cuts and Jobs Act of 2017 , which repealed the individual mandate. The AHCA was a significant issue in the midterm elections the following year , which saw the election of a Democratic House majority and defeat of several of the bill's supporters for re-election. Members of Congress who voted for the AHCA were more likely to lose their re-election bids. The nonpartisan Congressional Budget Office projected that
4389-593: The United States Department of Homeland Security to form standards for ID used to board airplanes. The bill passed in the House and Senate in December. Collins said, "This was the most difficult bill to bring from conception to birth that I can imagine being involved with. But that makes the victory doubly satisfying." Bush signed the bill, formally known as the Intelligence Reform and Terrorism Prevention Act , on December 17, 2004. In May 2005, Collins
4522-445: The employer mandate , which requires employers with greater than 50 employees to pay for health care for their employees. The bill was brought to the floor vote and the vote reached the predicted 49–50, majority being in favor of keeping the ACA as is. A tie would have allowed Vice President Mike Pence to cast a final tie breaking vote. The final vote was to be McCain, who walked to the floor in near silence and held out his hand. In
4655-419: The presidency for the first time since the ACA came into effect. Upon the start of the 115th Congress, Congressional Republicans sought to pass a partial repeal of the ACA using the reconciliation process, which allows legislation to bypass the Senate filibuster and pass with a simple majority in the Senate. With the support of President Donald Trump , House Republicans introduced the AHCA in early 2017, and
4788-645: The senior United States senator from Maine . A member of the Republican Party , she has held her seat since 1997 and is Maine's longest-serving member of Congress . Born in Caribou, Maine , Collins is a graduate of St. Lawrence University in Canton, New York . Beginning her career as a staff assistant for Senator William Cohen in 1975, she became staff director of the Oversight of Government Management Subcommittee of
4921-596: The "Alzheimer's Disease and Related Dementias Public Health Centers of Excellence" and aid statewide efforts to promote brain health and reduce cognitive decline. It passed the Senate and House and was signed by Trump in January 2019. In September 2018, Collins authored two bills as part of the Opioid Crisis Response Act, a bipartisan package of 70 Senate bills that would alter programs across multiple agencies in an effort to prevent opioids from being shipped through
5054-444: The "actuarial value" is an estimate of the percentage of total cost that a particular insurance plan is expected to cover. CBO reported that: The current law (ACA) established two taxes on high-income individuals (defined as income over $ 200,000 for individuals or $ 250,000 for couples, roughly the top 6% of earners), via a 0.9% Medicare payroll surtax on earnings over that threshold and a 3.8% tax on net investment income. The latter tax
5187-405: The "skinny" repeal of the ACA. In October, Collins called on Trump to support a bipartisan Congressional effort led by Lamar Alexander and Patty Murray to reinstate insurer payments, saying that what Trump was doing was "affecting people's access and the cost of health care right now". On December 14, 2017, the day the FCC was set to hold a vote on net neutrality, Collins and King sent the FCC
5320-416: The $ 150 billion is about 1.6%. There are many variables that affect premiums, deductibles, and out-of-pocket amounts, including (among others) age and health of plan participants, availability of subsidies, funding for high-risk pools, required insurance coverage elements, lifetime limits, maximum ratio of prices charged to older persons versus younger, and the quality of insurance offered. Regarding quality,
5453-411: The 1980s and 1990s, which included a mandate that all have coverage to prevent " free riders ", subsidy tax credits, and Medicaid reform. Heritage proposed funding program costs by taxing health insurance premiums paid by employers on behalf of workers (presently exempt from income), which would have affected all workers covered by employers, while ACA primarily relied on tax rate increases on roughly
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5586-554: The 1994 gubernatorial election, in the general election. She defeated him, 49% to 44%. Collins was elected to the Senate in 1996 . During the campaign she pledged that, if elected, she would serve only two terms. Collins was reelected in 2002 over State Senator Chellie Pingree , 58%–42%, in 2008 over Representative Tom Allen , 61.5%–38.5%, and in 2014 over Shenna Bellows , 68.5%–31.5%. In her first three reelection campaigns, she carried every county in Maine. In 2020 , Collins
5719-497: The ACA Medicaid expansion through January 1, 2020, and would disallow further enrollment after that date. The AHCA will include age-based tax credits for those who earn less than $ 75,000, or $ 150,000 for joint filers. The bill would have required insurance companies to cover pre-existing conditions. The AHCA used a standard of 'continuous coverage', defined by a 63-day coverage gap, where an individual who currently has insurance and
5852-433: The ACA's community rating provision (barring insurance companies from charging older people more than three times what they charge younger people) would increase cost disparities between age groups and would increase premiums for Americans more prone to illness; (3) the dropping of healthy people from the health insurance market ( adverse selection ) could lead to insurer "death spirals" that would decrease choice; and (4)
5985-427: The ACA, creating uncertainty that has likely adversely impacted enrollment and insurer participation, and then insisting that the exchanges are in difficulty as an argument for repealing the ACA. The Washington Post columnist Dana Milbank has made the same argument. Health insurance writer Louise Norris states that Republicans sabotaged the ACA through: The bills would allow states to continue to enroll persons in
6118-514: The AHCA legislation would lead to a loss of 924,000 jobs by 2026. The group also studied the BCRA, which would cost an estimated 1.45 million jobs by 2026, including over 900,000 in healthcare. The stimulus effects from tax cuts would initially create jobs, but would be offset by the larger declines in spending as the various parts of the law take effect. Further, gross state products would be $ 162 billion lower in 2026. States that expanded Medicaid would bear
6251-476: The AHCA were introduced into the House Energy and Commerce Committee and the House Ways and Means Committee on March 8, 2017 and passed both committees the next day. Both committees approved the AHCA on a party-line vote without a CBO report, prompting criticism from Democrats. House Minority Leader Nancy Pelosi argued that the bill should not proceed through Congress until the CBO completed its analysis of
6384-450: The AHCA would have increased the number of uninsured people by 23 million over 10 years, but would have decreased the federal budget deficit by $ 119 billion over the same period. Polling consistently showed that the AHCA was deeply unpopular with the American population during and after its evaluations in Congress. Business Insider stated that the AHCA was "the least popular major bill in decades", and major medical organizations, including
6517-567: The Better Care Reconciliation Act of 2017 (BCRA), a healthcare bill containing provisions largely similar to those of the AHCA. The BCRA was never voted on in its original form due to opposition from several Republican senators. Senate Majority Leader Mitch McConnell instead sought to pass the Health Care Freedom Act (HCFA) , which was colloquially referred to as a "skinny repeal" by Republicans since it would only repeal
6650-580: The CBO's score would be "meaningless". These criticisms from the White House are unusual: prior administrations of both parties had refrained from questioning the CBO's credibility, and many members of Congress respect the CBO as a neutral body. The bill next went to the House Budget Committee , which passed it on March 16 by 19 to 17 votes, with three Republicans from the conservative Freedom Caucus joining Democrats in opposition. It next went to
6783-668: The Center for Family Business at Husson University in Bangor, Maine . Collins was first elected to the Senate in 1996 . She was reelected in 2002 , 2008 , 2014 , and 2020 . She chaired the Senate Special Committee on Aging from 2015 to 2021 and the Senate Committee on Homeland Security and Governmental Affairs from 2003 to 2007. Collins is a senior Republican woman in the Senate, the dean of Maine's congressional delegation, and
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#17328580948826916-573: The Committee on Governmental Affairs (which later became the Committee on Homeland Security and Governmental Affairs) in 1981. Governor John R. McKernan Jr. then appointed her commissioner of the Maine Department of Professional and Financial Regulation in 1987. In 1992 President George H. W. Bush appointed her director of the Small Business Administration 's regional office in Boston . Collins became
7049-538: The Comprehensive Addiction and Recovery Act into law on July 22, 2016. On August 8, 2016, Collins announced that she would not vote for Donald Trump , the Republican nominee in the 2016 presidential election . She said that as a lifelong Republican she did not make the decision lightly but felt he was unsuitable for office, "based on his disregard for the precept of treating others with respect, an idea that should transcend politics". She considered voting for
7182-535: The House Republicans that the vote the following day would be their only chance to repeal the Affordable Care Act, a goal long sought after by Republicans in Congress. The following morning the bill was brought to the House floor after being approved by the House Rules Committee for four hours of debate preceding the vote, which was expected in the afternoon. It was reported that a couple hours before
7315-532: The House of Representatives voted in favor of repealing the Patient Protection and Affordable Care Act and passing the American Health Care Act with a narrow vote of 217 to 213. Upon the bill's passing, congressional Republicans rushed to the White House for a televised celebration. 217 Republican Congressmen voted for the bill, while all 193 Democrats and 20 Republicans voted against it. Most of
7448-572: The Infant Plan of Safe Care Act, which mandated that states ensure safe care plans are developed for infants who are drug-dependent before they are discharged from hospitals. These provisions were included in the Comprehensive Addiction and Recovery Act , legislation that created programs and expanded treatment access alongside implementing $ 181 million in new spending as part of an attempt to curb heroin and opioid addiction. Obama signed
7581-553: The Medicaid expansion in the current law (ACA), reducing the inflation index used to compute per-enrollee payments to states, and eliminating coverage mandates. While the nominal spending amounts continue to rise but at a slower pace, adjusted for inflation the amounts are actually cut moderately relative to 2017 levels. According to researchers at the Milken Institute School of Public Health at George Washington University ,
7714-501: The Republican House (AHCA) and Senate (BCRA) bills was very negative (i.e., opposed), with approval ratings between 12 and 38%, and disapproval ratings between 41% and 62%, measured between March and June 2017 (refer to "Specific poll results" table below for sources). Views were split along party lines. For example, the monthly Kaiser Family Foundation health tracking poll for May 2017 indicated that: Health care experts from across
7847-433: The Republican leadership to "use this additional time to hold public hearings ... on the policies in the bill, especially the radically conservative Cruz/Lee proposal released to the public only five days ago." On July 17, Senators Mike Lee (R-UT) and Jerry Moran (R-KS) came out against the bill, joining Rand Paul and Susan Collins who already opposed it, making it impossible for Republicans alone to pass it through. It
7980-546: The Republican-controlled FCC. The measure was meant to restore Obama-era net neutrality rules. In 2017, The Lugar Center , a Washington, D.C.-based nonprofit founded by Senator Richard Lugar , released a bipartisan index in cooperation with Georgetown University that ranked Collins the most bipartisan senator during the first session of the 115th Congress (and the only U.S. Senator from the Northeast ranked among
8113-599: The Republicans who voted against the bill are members of the centrist Tuesday Group, and only one member of the Freedom Caucus voted against the bill. The Senate developed several amendments / bills to modify the AHCA bill that had passed in the House, but none had received enough votes in the Senate to pass as of July 28, 2017. These included the: Under the various Senate bills, the CBO estimated that relative to current law, millions more would be without health insurance and
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#17328580948828246-457: The Richard E. Dyke Center for Family Business at Husson College . She served in this post until 1996, when she announced her candidacy for the U.S. Senate seat being vacated by her former boss, William Cohen, who retired to become United States Secretary of Defense under President Bill Clinton . With Cohen's public endorsement, she won a difficult four-way primary and faced Brennan, her opponent in
8379-605: The Secretary of Transportation to request nominations and make determinations in regard to roads that would be designed under a voluntary, community-based program and was signed into law by Trump in September of that year. After the Senate Intelligence Committee held a closed-door meeting with Michael Cohen , Collins said senators "clearly need to re-interview some witnesses whose accounts [Cohen] contradicts". Her comment
8512-447: The Senate by using the reconciliation rule. In 2015, U.S. health care costs were approximately $ 3.2 trillion, or nearly $ 10,000 per person on average. Major categories of expense include hospital care (32%), physician and clinical services (20%), and prescription drugs (10%). U.S. costs in 2016 were substantially higher than other OECD countries, at 17.2% GDP versus 12.4% GDP for the next most expensive country (Switzerland). For scale,
8645-658: The Senate to approve funding for a new training ship for the academy was her "number one priority" and that funding was included in Trump's proposed budget while she would still seek further funds through other measures. In July 2019, Collins cosponsored the Fallen Journalists Memorial Act, a bill introduced by Ben Cardin and Rob Portman that would create a new, privately funded memorial that would be constructed on federal lands in Washington, D.C. in order to honor journalists, photographers, and broadcasters who died in
8778-499: The Senate. She was one of three Republicans to vote against a partial repeal of the Affordable Care Act . She was the sole Republican to vote against confirming Amy Coney Barrett to the Supreme Court and one of three to vote to confirm Ketanji Brown Jackson . As a pro-choice Republican, she drew scrutiny for her vote to confirm Brett Kavanaugh , who she believed would not support overturning Roe v. Wade . In 2022, he joined
8911-728: The Supreme Court. Barrett was confirmed by a vote of 52–48. On January 6, 2021, Collins was participating in the certification of the Electoral College vote count when Trump supporters attacked the United States Capitol . She was on the Senate floor listening to speeches related to the objection to counting Arizona's votes when the Sergeant at Arms of the U.S. Senate and U.S. Capitol Police removed Vice President Mike Pence and Senators Mitch McConnell and Chuck Schumer . She called
9044-467: The U.S. Postal Service and grant doctors the ability to prescribe medications designed to wean opioid addictions. The bills passed 99 to 1. In February 2019, Collins was one of five senators to sponsor legislation authorizing the Treasury Department to mint coins honoring George H. W. Bush and Barbara Bush under the Presidential $ 1 Coin Act of 2005 and introduced the Reviving America's Scenic Byways Act of 2019 along with Ben Cardin . The bill required
9177-414: The U.S. government, but with 52 seats in the 100-member Senate, Republicans would still have to rely on at least some Senate Democrats to overcome a filibuster . However, Senate rules provide for a special budget rule called reconciliation , which allows certain budget-related bills to bypass the filibuster and be enacted with a simple majority vote. Republican leaders were seeking to pass the AHCA through
9310-618: The benefit or a reduction of $ 5,680 in annual taxes on average. Those with incomes over $ 1 million (the top 0.4%) would see a tax decrease of $ 51,410 on average, receiving 46% of the benefit. In general, those with incomes over $ 50,000 would see a tax cut, while those with income below $ 50,000 would see a tax increase. Those with income below $ 10,000 would see a tax cut as well, but this benefit would be offset overall by reductions in Medicaid availability. The effects overall would worsen income inequality . The Center on Budget and Policy Priorities (CBPP) reported that "The House bill would represent
9443-401: The bill as a "conservative wish list" that would provide for "monumental, exciting conservative reform". Conservative economist Douglas Holtz-Eakin described the AHCA as "a good start". But conservative members of the Republican Party quickly raised skepticism about the proposed reform as they would prefer a complete repeal of the PPACA. The White House sent Mick Mulvaney , executive of
9576-530: The bill being passed to floor debate, including a repeal without replace bill, the Republican senate leadership attempted to pass the Health Care Freedom Act (HCFA), referred to as a "skinny repeal." The skinny repeal, which was still being drafted on July 27, only repeals some provisions of the ACA , among them the individual mandate , requiring that all Americans buy insurance or pay a tax penalty, and parts of
9709-419: The bill from consideration rather than go through with a full House vote that would have failed. The comparatively "lightning fast" legislative movement for the AHCA through the House was in contrast to the Affordable Care Act, which took months of negotiations, committee markup, and debate before passage in 2010. The quick process prompted complaints from Democrats "that the Republicans were rushing to approve
9842-548: The bill passed the House in a close vote on May 4, 2017. All House Democrats, along with several members of the centrist Tuesday Group and some other House Republicans, voted against the AHCA. The bill would have repealed the individual mandate and the employer mandate , dramatically cut Medicaid spending and eligibility, eliminated tax credits for healthcare costs, abolished some taxes on high earners, and altered rules concerning pre-existing conditions and essential health benefits . Senate Republicans initially sought to pass
9975-424: The bill was (1) "almost certain" to reduce overall health care coverage and increase deductibles and (2) would phase out the Medicaid expansion. Among the key concerns identified by health-care experts were that (1) the tax credits funded at the level proposed in the bill are insufficient to pay for individual insurance, and could lead to Americans dropping out of the health care market; (2) the bill's elimination of
10108-475: The bill's "awfulness is almost surreal", writing that what Republican congressional leadership "came up with instead was a dog's breakfast that conservatives are, with some justice, calling Obamacare 2.0. But a better designation would be Obamacare 0.5, because it's a half-baked plan that accepts the logic and broad outline of the Affordable Care Act while catastrophically weakening key provisions." On March 23, 2017 (the seventh anniversary of ACA and one day prior to
10241-403: The bill, were not convinced that the healthcare replacement effectively abolished some elements of the Affordable Care Act, most prominently the essential health benefits . To achieve success in the House, Republicans could not afford more than twenty-one members of their own party voting against the bill, and several days before the vote, dissent within the party, largely from the Freedom Caucus,
10374-455: The bill. Representative Richard Neal , the ranking Democratic member of the House Ways and Means Committee, stated: "To consider a bill of this magnitude without a CBO score is not only puzzling and concerning, but also irresponsible." Trump administration officials, including budget director Mick Mulvaney and economic adviser Gary Cohn , preemptively attacked the CBO, with Cohn saying that
10507-486: The brunt of the economic impact, as government funds would be reduced more significantly. Under both the ACA (current law) and the AHCA, CBO reported that the health exchange marketplaces would remain stable (i.e., no "death spiral"). Yale Law School professor Abbe R. Gluck, the director of the Solomon Center for Health Law and Policy, writes that Republican elected officials have taken a variety of steps to "sabotage"
10640-428: The budget deficit would be reduced moderately (roughly 5% or less over a decade). The effect on insurance premiums would vary widely in the exchange marketplaces (the non-employer market created by Obamacare) depending on the specific legislation. In the Senate, Majority Leader Mitch McConnell appointed a group of 13 Republican Senators to prepare a bill. Democrats, independents, and other Republicans were excluded from
10773-430: The calls immediately. In 2009, Collins was criticized for blocking flu relief funding during the swine flu pandemic. She said she had done so on procedural grounds, because the funding did not belong in a stimulus bill: "while worthwhile, [it does] not boost our economy," and "it does not make sense to include $ 870 million for pandemic flu preparedness." In April 2010, Collins and Senator Joe Lieberman issued
10906-417: The campaign, she received little support from Republican leaders and was criticized by conservative groups for her more liberal views on social issues. She lost the general election, receiving 23% of the vote and placing third behind Democrat Joseph E. Brennan and the winner, Independent candidate Angus King , her future Senate colleague. In December 1994, Collins became the founding executive director of
11039-485: The challenges of our time." The announcement came as a surprise, as Collins was considered a possible supporter of his nomination, and it occurred while the nomination was being filibustered. The filibuster on Hagel's nomination was defeated, and he was confirmed later that month. In May 2013, following a report that the Internal Revenue Service had put additional scrutiny on conservative groups, Collins said
11172-615: The community rating program. As revised by the MacArthur Amendment, the ACHA weakens protections for patients with preexisting conditions; under this version of the bill, insurers would be able to charge people significantly more if they had a pre-existing condition. On May 3, House Republicans announced that they had enough votes to pass the bill, after amending it to include an additional $ 8 billion over five years to subsidize insurance for people with pre-existing conditions. On May 4, 2017,
11305-655: The cost savings (deficit reduction) under AHCA and BCRA is due to reductions in Medicaid spending and coverage relative to current law. CBO estimated that there would be 15 million fewer Medicaid enrollees relative to current law by 2026, the largest component of the reduced coverage discussed above. CBO estimated that Medicaid spending under BCRA would be 26% lower in 2026 and 35% lower in 2036 relative to current law. This would reduce Medicaid spending in 2036 from 2.4% GDP under current law to 1.6% GDP. The reductions are driven by reduced funding to states for those who became covered under
11438-497: The country is "going to be living with Obamacare for the foreseeable future", while Trump said that it was tough to pass the bill without support from Democrats; Ryan and Trump both said they were going to move forward on other policy issues. Through the various iterations of bill it has been nicknamed variously as Trumpcare , Ryancare , Republicare , and pejoratively as Obamacare-Lite , and Wealthcare . In April 2017, House Republicans tried to reconcile their divisions with
11571-519: The coverage impact of the ACA/Obamacare. It has been very accurate with respect to forecasting the number of uninsured and change in uninsured, but off significantly in forecasting the number of persons who would enroll in the exchanges. Instead, many more persons retained their employer-based plan than CBO had anticipated. CBO revises its forecasts for health insurance coverage due to current law (ACA/Obamacare) annually. The two bills that constituted
11704-472: The creation of the Department of Homeland Security while a Democratic effort to remove the bill's provisions fell short on a 52-to-47 vote that came after President George W. Bush lobbied against the vote. Collins and other senators said that Senate and House Republicans, as well as the White House, had given them an "ironclad promise" to essentially rescind provisions in the first spending bill to pass Congress
11837-419: The day of the scheduled vote, which coincided with the seven-year anniversary of the ACA's signing into law, party leadership continued to struggle with getting the required votes for the bill, and the vote was rescheduled for the following day, March 24, 2017, as requested by the White House. The night before the rescheduled vote, Trump, in a final effort to negotiate with those opposing the bill, announced to
11970-541: The deficit would not increase, taxes would not go up on people making less than $ 250,000, and that people over 55 years old would not lose benefits or pay higher out-of-pocket costs." Democratic Representative Joe Crowley of New York offered an amendment that during the 2010 Affordable Care Act debate had been proposed by Republican Representative Kevin Brady of Texas, requiring "that the bill be posted online for 72 hours before any votes were taken on it, and that every member put
12103-421: The draft's release, it was amended to provide that someone who went without coverage for 63 days or more would have to wait six months to obtain new coverage. The CBO evaluated the bill, concluding that relative to current law it would reduce the budget deficit by $ 473 billion over 10 years (roughly 5%), increase the number of uninsured by 17 million in 2018 and 27 million in 2020, and increase average premiums in
12236-434: The duration of Obama's presidency despite Republican efforts to repeal it. In the 114th Congress , Republicans passed a bill that would have repealed much of the ACA, but the bill was vetoed by Obama. After winning the 2016 presidential election , President Donald Trump promised to "repeal and replace" the ACA with a new law. The 2016 elections left Republicans in control of the executive and legislative branches of
12369-408: The expected vote, Ryan made a sudden visit to the White House to meet with Trump, in which Ryan told Trump that the bill did not have enough votes to pass in the House. Shortly after the time of the expected vote it was announced that the Republicans were withdrawing the AHCA from consideration, a decision made after Ryan met with Trump. Following the withdrawal, Ryan stated in a press conference that
12502-614: The experience "frightening and appalling." Collins later called the attack "a dangerous, shameful, and outrageous attack on our democracy" and blamed Trump for "working up the crowd and inciting this mob". She called on him to call off the rioters. When Congress reconvened after the Capitol was secure, Collins voted to certify the count. Toward the end of January 2021, Collins led a group of 10 Republican senators who requested that President Joe Biden join bipartisan negotiations when creating his COVID-19 economic relief package. After meeting with
12635-493: The first charge, and all Republicans to acquit on the second. In his second impeachment trial , she was one of seven Republicans to vote to convict Trump of incitement of insurrection . One of six children, Collins was born in Caribou, Maine , where her family operates a lumber business established by her great-great-great-grandfather, Samuel W. Collins, in 1844. Her parents, Patricia (née McGuigan) and Donald Collins (1925–2018), each served as mayor of Caribou. Her father,
12768-448: The floor before final passage. The motion to proceed on this version of the bill passed in a 51–50 vote, with a tie-breaking vote cast by Vice President Mike Pence; Senators Susan Collins and Lisa Murkowski diverged from their party and voted against the measure. Senator John McCain traveled to Washington for the vote, returning to Senate for the first time since his cancer diagnosis. After several failed votes within 24 hours of
12901-406: The following year. In 2004, Collins was one of the primary sponsors of legislation overhauling the U.S. intelligence community by creating a new post, Director of National Intelligence , to oversee budgets and most assets of the spy agencies, and mandating that federal agencies establish minimum standards for states pertaining to issuing driver's licenses and birth certificates along with directing
13034-404: The impact on the budget deficit in each of its scores, generally finding a moderate reduction relative to current law: For scale, CBO has estimated that the U.S. will add approximately $ 9.4 trillion to the debt total over the 2018-2027 period, based on laws in place as of January 2017. The $ 321 billion therefore represents a reduction of about 3.5% of the total debt increase over the decade, while
13167-513: The individual mandate and the employer mandate. On July 27, the Senate rejected the HCFA in a 51-to-49 vote, with Republican senators Susan Collins , Lisa Murkowski , and John McCain joining with all Senate Democrats in voting against it. In September 2017, some Republican senators pushed a renewed effort to repeal the ACA, but their bill never received a vote in the Senate. The 115th Congress ultimately did not pass an ACA repeal bill, though it did pass
13300-460: The largest transfer in modern U.S. history from low- and moderate-income people to the very wealthy." CBPP also wrote: "Millionaires would gain roughly $ 40 billion in tax cuts annually...roughly equivalent to the $ 38 billion that 32 million households in poverty would lose from cuts to their tax credits and Medicaid." Medicaid is the U.S. program for low-income children, adults, seniors and people with disabilities, covering one in five Americans. It
13433-491: The law significantly reduced income inequality after taxes and transfers. The Republican bills (AHCA and BCRA) essentially repeal all of the taxes, penalties and fees and postpone the "Cadillac tax" further. The Tax Policy Center estimated in March 2017 that the AHCA would significantly reduce taxes for the wealthy, with those IRS tax units (an approximation for families) earning over $ 200,000 per year (the top 6%) receiving 70.6% of
13566-402: The legislation received bipartisan support and predicted Russia would also attempt to interfere in the 2018 elections. In January 2019, Collins was one of 11 Republican senators to vote to advance legislation intended to block Trump from lifting sanctions on three Russian companies. She said she disagreed with "the easing of the sanctions because I think it sends the wrong message to Russia and to
13699-442: The line of duty. Collins called freedom of the press "one of our fundamental constitutional rights" and spoke of the risks of reprisals faced by reporters around the world for their work. In February 2020, Collins voted "not guilty" on both articles in the first impeachment trial of Donald Trump . On October 26, 2020, Collins was the only Republican senator to vote against the confirmation of Trump's nominee Amy Coney Barrett to
13832-436: The link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=HCFA&oldid=792813577 " Category : Disambiguation pages Hidden categories: Short description is different from Wikidata All article disambiguation pages All disambiguation pages American Health Care Act of 2017 The American Health Care Act of 2017 (often shortened to
13965-515: The majority opinion in Dobbs v. Jackson Women's Health Organization , which overturned Roe v. Wade . Collins has since resisted efforts to codify Roe. During the impeachment trial of Bill Clinton , Collins was one of 10 Republican senators to vote to acquit him on the first charge and one of five to vote to acquit on the second. During the first impeachment trial of Donald Trump , Collins joined all Senate Republicans but one in voting to acquit him on
14098-447: The marketplaces (non-group/non-employer-based) by roughly 25% in 2018 and by 50% in 2020. Roughly half the U.S. population would live in areas with no insurers participating in the marketplaces. On July 14, Senator John McCain had surgery to remove a blood clot . The next day, McConnell announced that the vote on proceeding to consider the bill would be deferred until McCain returned from his recuperation period. Senate Democrats urged
14231-524: The number of persons covered, moderately lower the budget deficit over a decade, reverse the tax increases on the top 5% (mainly the top 1%), dramatically cut Medicaid payments (25-35%) that benefit lower-income persons, and expand choice by allowing lower quality insurance to be purchased at lower prices for the young and middle-aged. Key provisions of the Republican Senate BCRA take effect over several years and include: Public opinion regarding
14364-604: The oligarch and close ally of Mr. Putin, Oleg Deripaska, who will in my judgment continue to maintain considerable [ownership] under the Treasury's plan." In 2018, Collins and Senators Tim Kaine , Catherine Cortez Masto , and Shelley Moore Capito authored the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act, legislation centered on providing a public health approach to Alzheimer's. The bill would authorize $ 20 million annually to establish
14497-405: The only New England Republican in the 116th , 117th , and 118th Congresses. Collins is the only Republican to represent a Northeastern state in the Senate. Thus far, Collins is the longest-serving Republican woman in the Senate, and since 2019, the only Republican official holding statewide office in Maine. Generally regarded as a moderate Republican , Collins is often a pivotal vote in
14630-404: The only two Republicans to vote for an unsuccessful Democratic measure that would have prevented bailouts, highlighted financial products of complexity and toughened consumer protection. In February 2013, Collins announced her opposition to the confirmation of Chuck Hagel for United States Secretary of Defense , citing her belief that Hagel's "past positions, votes and statements [do not] match
14763-406: The phaseout of the Medicaid expansion was likely to result in a loss of healthcare for poorer Americans. The nonpartisan Congressional Budget Office has evaluated ("scored") the AHCA (initial and revised) and BCRA with respect to health insurance coverage, impact on the annual budget deficit, cost of insurance, and quality of insurance (i.e., the actuarial value, or percent of costs a given policy
14896-565: The political spectrum – liberal, moderate, and conservative – agreed that the House Republican health care bill was unworkable and suffered from fatal flaws, although specific objections varied depending on ideological perspective. Experts agreed that the bill fell far short of the goals laid forth by President Donald Trump during his 2016 campaign – "Affordable coverage for everyone; lower deductibles and health care costs; better care; and zero cuts to Medicaid" – because
15029-424: The poverty level in states that did not expand Medicaid. The AHCA would have replaced the individual mandate with a provision that would allow an insurer to add a 30 percent surcharge to the premium if an individual goes without coverage for 63 days or more. The original draft of the BCRA would have repealed the ACA's individual mandate but it did not include the AHCA's continuous coverage provision. A few days after
15162-528: The process and given no information until the new bill was released on June 22, 2017. The Senate bill is called the Better Care Reconciliation Act of 2017. The bill's differences from the House bill reflected divergent opinions within the Republican caucus. The phase-out of the Medicaid expansion would be made more gradual, but funding for Medicaid as it stood before the ACA would be reduced. Eligibility for premium subsidies would be tightened for middle-class recipients, but some aid would be extended to enrollees below
15295-587: The proposed MacArthur Amendment. The MacArthur Amendment, developed by Representative Tom MacArthur of the Tuesday Group (representing more moderate Republicans) and Representative Mark Meadows of the House Freedom Caucus (representing the hard-line right). The language of the proposed amendment became available on April 25, 2017. The amendment allows insurers to charge enrollees in their 50s and early 60s more than younger enrollees. It also allows states to waive essential health benefits and certain sections of
15428-580: The revelation "contributes to the profound distrust that the American people have in government" and added that she was disappointed that Obama "hasn't personally condemned this and spoken out". In April 2014, the Senate debated the Minimum Wage Fairness Act (S. 1737; 113th Congress) . The bill would have amended the Fair Labor Standards Act of 1938 (FLSA) to increase the federal minimum wage to $ 10.10 per hour over two years. The bill
15561-546: The seat once held by Smith. After graduating from high school, she continued her education at St. Lawrence University in Canton, New York . Like her father, she was elected to the Phi Beta Kappa national academic honor society. She graduated from St. Lawrence magna cum laude with a bachelor's degree in government in 1975. Following graduation, Collins worked as a legislative assistant to U.S. Representative and later U.S. Senator William Cohen from 1975 to 1987. She
15694-477: The shooting. Collins and Lieberman issued a statement accusing the Departments of Justice and Defense of refusing "to provide access to their agents who reportedly reviewed Major Hasan's communications with radical extremist cleric Anwar al Awlaki and to transcripts of prosecution interviews with Hasan's associates and superiors, which DOD already provided to its internal review." In May 2010, Collins and Snowe were
15827-487: The top 10 most bipartisan senators). In January 2018, in response to the Trump administration 's not implementing congressionally approved sanctions on Russia, Collins said it was confirmed Russia had tried to interfere in the 2016 U.S. presidential election, adding, "not only should there be a price to pay in terms of sanctions, but also we need to put safeguards in place right now for the elections for this year." She noted that
15960-521: The top 5% of households. From Obama's inauguration in January 2009 until the November 2010 elections , both houses of Congress and the presidency were controlled by the Democratic Party. During the 2012 presidential election , Republican nominee Mitt Romney , running against Obama, promised to repeal the ACA, despite its similarity to Romneycare . After Romney's defeat, the ACA remained in effect for
16093-490: The vote on the American Health Care Act), former President Obama hailed the successes of the Affordable Care Act, including 20 million more Americans insured, preexisting conditions covered, young people staying on their parents' plans until 26, lowered costs for women's health care and free preventive care. Susan Collins Susan Margaret Collins (born December 7, 1952) is an American politician serving as
16226-412: Was a significant threat to its passage. Beyond the conservative members of the Freedom Caucus, there was continued opposition to the bill from more moderate Republicans in the House, such as from members of the center-right Tuesday Group , where there were concerns about loss of coverage and the potential of rising insurance costs. Amid the division between the Republicans, the party leadership, which
16359-600: Was also staff director of the Oversight of Government Management Subcommittee on the United States Senate Committee on Homeland Security and Governmental Affairs from 1981 to 1987. In 1987, Collins joined the cabinet of Governor John R. McKernan Jr. as Commissioner of the Department of Professional and Financial Regulation. President George H. W. Bush appointed her the New England regional director for
16492-471: Was challenged by Democratic State House Speaker Sara Gideon . The hotly contested race became the most expensive in Maine history, with Collins spending $ 23 million and Gideon nearly $ 48 million. The race also had national implications, as defeating Collins was a key part of the Democrats' strategy to achieve a Senate majority. Despite trailing Gideon in every public poll of the race, Collins defeated Gideon by
16625-665: Was given a veto threat by the White House, which was said by the Office of Management and Budget to oppose "the inclusion of problematic ideological provisions that are beyond the scope of funding legislation". In 2016, Collins authored the Safe Treatments and Opportunities to Prevent Pain Act, a provision intended to encourage the National Institutes of Health to further its research into opioid therapy alternatives for pain management, and
16758-414: Was increased division among House Republicans over the replacement, causing concerns among Republican Party leadership over having the votes needed to pass the bill. Among Republican defectors from the bill, the largest opposition came from members of the House Freedom Caucus , which consists of some of the most conservative members in the House. The Freedom Caucus members, among their primary objections to
16891-410: Was later revealed that John McCain was diagnosed with brain cancer , which was discovered during his surgery. On July 25, Senate Republicans released a significantly stripped-down version of the healthcare bill, containing only fundamental provisions of the repeal that all Republicans agreed on, designed to only pass the motion to proceed to floor debate, still allowing further amendments to be added on
17024-404: Was led by House Speaker Paul Ryan , attempted to ease concerns among the Freedom Caucus and others. President Trump also held numerous meetings with Republicans in the House leading up to the vote, though after negotiations with the Freedom Caucus over the ACA's essential health benefits, there was still a considerable amount of opposition from moderates and members of the Freedom Caucus alike. On
17157-461: Was not voted upon due to lack of support. On October 12, 2017, due to this failure of Congress to pass a repeal, President Donald Trump issued Executive Order 13813, titled an Executive Order to Promote Healthcare Choice and Competition . President Trump endorsed the bill after its release, calling it "our wonderful new Healthcare Bill" on Twitter. Speaker of the House Paul Ryan referred to
17290-480: Was one of 14 senators (seven Democrats and seven Republicans) to forge a compromise on the Democrats' use of the judicial filibuster , thus allowing the Republican leadership to end debate without having to exercise the nuclear option . Under the agreement, Democrats agreed they would filibuster Bush's judicial nominees only in "extraordinary circumstances"; three Bush appellate court nominees ( Janice Rogers Brown , Priscilla Owen , and William Pryor ) would receive
17423-416: Was president of the student council . During her senior year of high school in 1971, she was chosen to participate in the U.S. Senate Youth Program , through which she visited Washington, D.C. , for the first time and had a two-hour conversation with Maine's first female United States Senator , Margaret Chase Smith , also a Republican . Collins is the first program delegate elected to the Senate and holds
17556-669: Was seen as hinting at the Intelligence Committee's interest in speaking with Donald Trump Jr. again. In June, Collins cosponsored an amendment to form the John S. McCain III Human Rights Commission, which would hold hearings and briefings on human rights violations ahead of collaborations with the Trump administration to address the violations, and be included in a defense authorization bill McCain had helped create as Armed Services Committee chairman. In her May 2019 commencement speech at Maine Maritime Academy , Collins said getting
17689-506: Was strongly supported by Obama and many Democratic senators but strongly opposed by Republicans in the Senate and House. Collins tried to negotiate a compromise bill that centrist Republicans could agree to but was unable to do so. In May 2016, the Senate passed an appropriations bill containing an amendment by Collins that she said would help prevent the Department of Housing and Urban Development from gaining "national zoning authority for every neighborhood in our country". The legislation
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