Susan Collins (left) and Sara Gideon are pictured at the Decision Maine debate in Portland on Sept. 11. Credit: Brianna Soukup / Portland Press Herald

Brenda Power of Dedham is a retired educator and editor.

Susan Collins said she does not support a health care public option during the Sept. 11 U.S. Senate debate. Any Mainers who are concerned about health care costs and the survival of rural hospitals should think carefully about re-electing a senator who appears to prioritize tax cuts for the wealthy over common-sense healthcare reforms.

Mainers voted in a major MaineCare expansion, through the Affordable Care Act, on Nov. 7, 2017, with strong support (59 percent to 41 percent). A mere six weeks later, Collins voted for a tax bill that included tax breaks for the wealthy that also gutted a key provision of the ACA.

This vote was unpopular with Mainers because it destabilized insurance markets, favored the wealthy over the middle class, and would likely lead to higher health care premiums. So at the time, Collins stated repeatedly that she had received an “ironclad” commitment from Senate leader Mitch McConnell that he would support legislation to lower healthcare costs in exchange for her vote. She assured Mainers she would hold McConnell to this promise.

Yet these reforms have never materialized. Instead, Republicans have argued that this vote against one provision of the ACA invalidates the entire law. Their case will be presented to the Supreme Court on Nov. 10.

Collins had plenty of leverage over the past three years to get healthcare cost relief for Mainers. She didn’t use it. At any time, Collins could have withheld her key “yes” votes on dozens of anti-choice and anti-ACA judges, many of whom were narrowly confirmed, insisting instead on votes for those promised health care reforms.

Her vote for Brett Kavanaugh is infamous, as is his voting record against women’s reproductive rights. Less publicized were her votes for judges like Steven Grasz who received ratings of “not qualified” from the American Bar Association. Grasz is an advocate for conversion therapy and has called Roe v. Wade “morally bankrupt.” This is just one of dozens of judges Collins supported for lifetime appointments, voting again and again for men who oppose women’s reproductive rights and everyone’s access to health care.

Sara Gideon supports thoughtful health care reform. The public option that both Gideon and Joe Biden champion is a moderate, popular approach that will increase the number of people able to afford insurance and decrease the premium costs of those already insured by allowing anyone to buy into the Medicare program. Gideon and Biden also want to increase subsidies to make healthcare coverage more affordable for the middle class. Biden will finance these reforms by rescinding the tax giveaway for the rich and increasing taxes on people earning over $400,000 annually.

In the debate, Collins said she doesn’t support a public option because it would harm rural hospitals. This stance makes no sense — rural hospitals suffer far more financially from treating uninsured patients who crowd their emergency departments and are unable to pay for services. A more sustainable approach is advocated by Gideon: Increase hospital Medicare reimbursements to expand rural hospital funding.

Collins’s vote to weaken the ACA in 2017 may prove to be the catalyst for millions of Americans losing their healthcare in 2021. We’ll know when the Supreme Court renders their decision next spring. If the ACA is struck down, Mainers who now have MaineCare through the expansion under the ACA will no longer be covered.

A senator who represents the will of Mainers would never trade our health security for tax cuts to the wealthy. But that is exactly what I believe Collins did.

Correction: A previous version of this column said Sen. Susan Collins voted to confirm Judge Lawrence VanDyke. Collins voted no on his nomination.