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This is what Susan Collins heard about health care while she was home

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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Defector of the Day: Susan Collins

Each day leading up to the Senate vote, we'll take a closer look at a Republican senator who seems to be on the fence on the Better Care Reconciliation Act, what they want, and what role they're likely to play in the debate. Today we look at one of the most critical votes: Sen. Susan Collins (R-ME).

Senator Susan Collins Mark Wilson/Getty Images

Most Republican senators spent their Fourth of July decidedly avoiding the crowds, as the Washington Post reported last night. Only four of the 52 attended their local parades.

One of the few who did is among the most crucial swing votes on the Senate Republican health care bill: Susan Collins of Maine.

Collins already opposes the bill, and it's hard to imagine she heard much on the holiday that would change her mind.

The four-term senator is probably the most moderate member in the chamber. She has expressed concerns on a variety of issues in the GOP plan: proposed spending cuts to Medicaid, protections for people with preexisting medical conditions, and defunding Planned Parenthood.

Given Senate Majority Leader Mitch McConnell's thin margin for error — he can lose only two of his 52 members — he could still make a play for Collins's vote. We'll know more when leadership releases a revised bill in the coming days.

Collins is one of several Republican senators who has said she wants to keep some of Obamacare's taxes on the wealthy. If McConnell kept those taxes, he could increase the bill's financial aid for people buying private insurance. Some outside experts are doubtful that the additional money will make up the current divide between the GOP bill's assistance and that of Obamacare.

Maine is not a Medicaid expansion state, but Collins, who is reportedlyweighing a run for governor next year, has also said she wants to soften the cuts to the state-federal program. The GOP bill would place spending caps on Medicaid for the first time, but McConnell could reduce the size of those cuts with a tweak to the cap's mechanics.

Collins also opposes defunding Planned Parenthood, as the current plan does. She has said she would want to get a vote to remove that provision from the bill, but it's unclear whether, if the defunding remained after that vote, she would vote against the final bill.

Given the unpopularity of the bill and the projected coverage losses — Collins has said flatly she opposes a plan that causes tens of millions fewer people to have health insurance — it's hard to know whether any changes would be enough to persuade Collins to come around and support it.

But she's left the door cracked open for compromise.

“I heard, over and over again, encouragement for my stand against the current version of the Senate and House health-care bills," Collins told the Post.

We'll see next week.

Chart of the Day

Javier Zarracina/Vox

North Carolina's progress on black women's mortality during childbirth. A Medicaid-funded program has eliminated a racial health disparity in the state. Read more from Vox's Julia Belluz.

Kliff’s Notes

  • Your daily top health care reads, with research help from Caitlin Davis

Today's top news

  • “Parades become backdrop for debate on GOP push on health care”: “Critics of GOP plans in Congress to overhaul the Obama health law tried to put Republicans on the defensive on Tuesday at various parades around the nation marking Independence Day, as Republicans in Congress continue to look for a deal on a Senate health care bill, and opponents try their best to derail those legislative efforts.” —Jamie Dupree, Atlanta Journal-Constitution
  • “RNC to Democrats: Where's your plan to fix Obamacare?”: “The Republican National Committee is out with a new ad criticizing Democrats for failing to put forward their own plan to fix Obamacare and urging them to work with Republicans to reform the healthcare system. The roughly 90-second ad features notable Democrats, including Hillary Clinton, Sen. Elizabeth Warren of Massachusetts and Sen. Al Franken of Minnesota, as well as Sen. Bernie Sanders, I-Vt., admitting there are problems with the 2010 healthcare law and that fixes are needed.” —Melissa Quinn, Washington Examiner
  • “Indiana GOP asked Facebook for Obamacare horror stories. The responses were surprising.”: “On Tuesday morning, within 24 hours of posting the question, the Indiana GOP's post had collected more than 1,500 comments, the majority in support of Obamacare. Since then, the post has gone viral — with more than 7,500 comments and 5,400 shares by noon on Wednesday.” —Ryan Martin, Indianapolis Star
  • “Congress Moves to Stop I.R.S. From Enforcing Health Law Mandate”: “Congress is moving to prevent the Internal Revenue Service from enforcing one of the more unpopular provisions of the Affordable Care Act, which requires most Americans to have health insurance or pay a tax penalty. The plan is separate from Republican efforts to repeal the health care law, and appears more likely to be adopted because it would be written into the annual spending bill for the Treasury and the I.R.S.” —Robert Pear, New York Times

Analysis and longer reads

  • "GOP's Health Plan Should Be More Ambitious, Not Less”: “Keeping in mind what a lousy form of coverage Medicaid is, I think it would make more sense to direct any additional federal resources to help people with low incomes get private insurance. The bill could provide those who need it with larger tax credits, or with money toward their deductibles.” —Ramesh Ponnuru, Bloomberg
  • “Senator Cruz's Healthcare Reform Proposal Creates A Monster "Income Cliff"”: “[If] you want the premiums to be affordable to those of lower income, you have to start with pretty high subsidies. If you don't want to place a high effective marginal tax rate on people, you have to phase out that subsidy at a fairly slow rate. But, when you do that, the program ends up costing a lot of money, at least if there are a lot of people in these community rated pools. Ted Cruz and his friends, if they didn't know this before, are about to find it out.” —Seth Chandler, Forbes
  • "How the GOP and Democrats might begin to compromise on health care”: “Democratic legislators in recent weeks have hinted at a number of long-ignored policy ideas that, under the right circumstances, could form the basis for a health bill that garners the requisite votes in the Senate and House. What might that bill look like? Democrats don’t have a single answer. But STAT’s interviews with senators, lobbyists, Capitol Hill staffers, and outside analysts at least provide some outlines of the picture, however blurry it may be.” —Lev Facher and Erin Mershon, STAT

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