The country owes Senator Susan Collins, of Maine, a big vote of thanks.
Absent her steadfastness over the past few months, the G.O.P. might have
succeeded in blowing up Obamacare. If that had happened, many millions
of Americans would now be facing the possibility of losing their
health-insurance coverage, while countless seniors and sick people would
be on the hook to pay much higher insurance premiums.

In July, Collins joined John McCain, of Arizona, and Lisa Murkowski, of Alaska, in opposing the so-called skinny repeal—their votes doomed
Senate Majority Leader Mitch McConnell’s most active attempt at getting
an Affordable Care Act repeal bill through the upper chamber of
Congress. On Monday, Collins issued what was widely interpreted as the
death knell for the bill put forward by Lindsey Graham, of South
Carolina, and Bill Cassidy, of Louisiana, which represents the
Republicans’ final repeal effort before a September 30th legislative
deadline. Rejecting a cynical effort to buy her vote by providing more
federal money to her home state, Collins pointed out that the future spending cuts contained in the bill would “more than
offset any short-term influx of money.” “But even more important,” she
went on, “if senators can adjust a funding formula over a weekend to
help a single state, they could just as easily adjust that formula in
the future to hurt that state. This is simply not the way that we should
be approaching an important and complex issue that must be handled
thoughtfully and fairly for all Americans.”

Contrary to the suspicions of some people on the right, Collins isn’t a
closet Democrat. She voted to confirm Neil Gorsuch to the Supreme Court,
and for all but two of Donald Trump’s Cabinet nominees. In 2010, she
voted against the A.C.A.; in 2011 and 2015, she voted to repeal it. On
many occasions, she has criticized the 2010 reform for offering
Americans limited choices and high premiums and deductibles. But, unlike
most of her G.O.P. colleagues, Collins has also defied the Party line
and recognized some of the good that Obamacare has done. The A.C.A. “has
allowed millions of individuals and families to obtain health insurance
for the first time,” she said when she voted against the skinny-repeal bill. “It has also brought important patient protections like those for people with pre-existing
conditions and prohibitions on annual and lifetime limits and on
insurance payments for needed care.”

Back in January, Collins joined with Bill Cassidy—whose current bill she
now opposes—to sketch a hybrid approach to health-care reform. States
that wanted to retain Obamacare would be allowed to do so, and they
would keep virtually all the federal funding that was allotted to them
under the 2010 law. But states could also opt out of Obamacare and use
the A.C.A. money to create a “market-based system”—with the stipulation
that they had to maintain some of the regulations that the A.C.A.
introduced, such as the ban on insurers barring people with preëxisting
conditions.

The Cassidy-Collins proposal didn’t go anywhere. Republicans hated the
idea of paying for states like California and New York to keep
Obamacare; Democrats wanted to maintain the A.C.A. nationwide. As the
G.O.P.’s leadership (and Cassidy, too) got behind more radical repeal
measures, Collins gradually distanced herself from her party.

It should be noted that health-care advocacy groups and Democratic activists in Maine helped along this evolution by filling Collins’s in-box, crowding her public meetings, and generally putting pressure on her to come out against the Republican repeal efforts. When she did this, in July, she said, “We are dealing with an issue that affects millions of Americans and one-sixth of the economy, and we need to approach reforms in a very careful way. That means going through the regular process of committee hearings, receiving input from expert witnesses, such as actuaries, governors, advocacy groups, and health-care providers; and vetting proposals with our colleagues on both sides of the aisle.”

In August, when Lamar Alexander, the head of the Senate Health-Care
Committee, announced that he would hold hearings on fixing the problems
of the A.C.A., Collins welcomed the move. And when McConnell
short-circuited this bipartisan effort by throwing his support behind
the hastily cobbled-together Graham-Cassidy repeal bill, Collins reacted
skeptically, saying she had serious concerns. On Monday, when she
announced her opposition to the bill, she aired these concerns.

“Some states could allow higher premiums for individuals with
preëxisting conditions, such as asthma, cancer, heart disease,
arthritis, and diabetes,” Collins said. “States could also limit
specific categories of benefits for Affordable Care Act policies, such
as eliminating coverage for mental-health or substance-abuse treatment.”
In addition, Collins pointed out that doctors, patient advocates,
hospitals, and insurers all agreed that the legislation would “lead to
higher premiums and reduced coverage for tens of millions of Americans.”

To her great credit, Collins also called out Graham-Cassidy’s assault on
Medicaid, the federal program that provides health-care coverage for
Americans of modest means. Under Obamacare, the income eligibility
thresholds for Medicaid were raised somewhat, enabling about fourteen
million people to get covered. Mimicking previous G.O.P. proposals, the
Graham-Cassidy bill would roll back this highly successful expansion and
convert the rest of Medicaid to a block-grant program. “Expert
projections show that more than one trillion dollars would be taken out of the
Medicaid program between the years 2020 and 2036,” Collins said. “This
would have a devastating impact to a program that has been on the books
for fifty years and provides health care to our most vulnerable citizens,
including disabled children and low-income seniors.”

In a party that was less ideological and less dominated by rich,
right-wing donors than today’s G.O.P., all of these points would be
regarded as uncontroversial. According to a new CBS News poll, just twenty per cent of Americans approve of the Graham-Cassidy bill,
and the earlier G.O.P. repeal proposals were just as unpopular. But,
despite its chronic lack of public support, the G.O.P.’s effort to
sabotage the health-care system came within a few votes of succeeding in
the Senate. For now, at least, it appears to be dead. On Tuesday afternoon, Republican leaders reportedly agreed not to hold a vote on the Graham-Cassidy bill. If this really is the end of the effort to repeal Obamacare, a few Republicans of character will have played a key role. And history will recall that Susan Collins was in the vanguard.