Politics
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Hospital and birthing center closures. Healthcare workforce shortages. Rising insurance premiums. As Mainers grapple with increasing health-related costs and dwindling access to care, those issues have become a focal point of the U.S. Senate race.
Incumbent Republican U.S. Sen. Susan Collins and Democratic nominee Troy Jackson have sparred over healthcare during debates and on the airwaves. The candidates differ in their overarching approaches to healthcare — Jackson, a proponent of Medicare for All, and Collins, a critic of a “big government” healthcare takeover.
At the center of many of their arguments over healthcare is President Donald Trump’s signature spending package, known as the “One Big Beautiful Bill,” which is expected to slash Medicaid funding in Maine and across the country.
Jackson, like many Democrats across the country, has tried to pin the healthcare cuts on Collins. Collins, who voted for a procedural motion to advance the bill but against the final package, has in turn touted the rural healthcare fund she secured in the bill during negotiations.
The Rural Health Transformation Program could mitigate but will not fully offset the larger cuts in the law, said Zachary Levinson, project director of the KFF project on hospital costs.
Maine was awarded $190 million in initial program funding in fiscal year 2026, which has all been committed as of this fall for a range of projects such as hospital financial sustainability, workforce recruitment and training, and technology improvements.
While the program was established in part to address concerns about the impact of Trump’s spending law on rural hospitals, the funding is being used for broader purposes than that and has restrictions that limit its ability to address urgent needs, Levinson said.
The votes
Ads from Jackson’s campaign and supportive super PACs claim Collins cast the deciding vote on the “One Big Beautiful Bill.”
In late June 2025, Collins voted to advance the bill, a 51-49 vote. Throughout the negotiation process, Maine’s senior senator expressed concern about the impact the bill would have on rural hospitals and on some Medicaid recipients, though she supported adding work requirements to the low-income healthcare program. Days later, Collins voted against the final package, which narrowly passed in the Senate with Vice President JD Vance casting the tie-breaking vote.
Collins has repeatedly justified her vote to advance the bill, arguing that she otherwise would not have been able to include the $50 billion Rural Health Transformation Program that she authored in the package.
Collins has also highlighted the program in a campaign ad, which touts the funding without mentioning the “One Big Beautiful Bill.”
Jackson equated Collins’ approach to “an arsonist who helped set the fire, and then she wants credit for bringing a cup of water to put it out” during a debate on Oct. 6. He has also pointed out that her Republican colleagues had called her a “team player” for advancing the legislation.
At the time, Sen. John Hoeven, a Republican from North Dakota, told the Boston Globe that Republicans knew that when it came to the final vote, Collins likely “couldn’t get there just because of her state.”
Democratic U.S. Rep. Alexandria Ocasio-Cortez of New York weighed into the matter during her visit to Portland last week.
“There’s a lot of procedural votes that say, ‘You can go ahead, you can go ahead.’ It doesn’t just show up on the floor one day,” Ocasio-Cortez said. “At every single moment, you have an opportunity to stand up and say no.”
Snags
Maine applied for $200 million through the program last November and was awarded $190 million at the end of December.
In late March, Collins claimed that the funding had been in jeopardy because “the state missed milestones and provided inadequate information to the Centers for Medicare & Medicaid Services.” Collins said she spoke with CMS Administrator Dr. Mehmet Oz and that CMS worked with the state to bring it into compliance.
However, according to Lindsay Hammes, press secretary for the Maine Department of Health and Human Services, at no point had CMS indicated to Gov. Janet Mills’ administration that Maine’s responses were untimely, inadequate, or that the funds were potentially at risk. Hammes said the department submitted a fully allocated budget for the program to CMS that was approved in March.
On Oct. 15, CMS confirmed that the totality of Maine’s grant award was obligated, meaning the state has legally committed its allocated funds. The program uses a cost-reimbursement model, so funds will be drawn down as expenses are accrued.
CMS did not respond to questions about whether Maine’s funding had ever been at risk. Instead, an unnamed spokesperson said in an email that it is standard procedure for CMS to request states amend budgets and adjust initiatives during grantmaking. CMS maintains ongoing oversight through reporting, monitoring, and annual progress assessments, the spokesperson said.
Maine and several states had to change their initial plans to fit CMS guidelines.
For instance, Maine initially proposed using some funding for uncompensated care payments and provider payments for essential health services to people who are uninsured. However, those plans were removed from the final budget.
While not included in the text of the law, CMS guidance says the funds are not intended “to be used for perpetual operating expenses, rather for investments… that will have sustainable impact beyond the end of the program.”
Also, payments to providers for services have a number of limits. They cannot exceed 15% of a state award in a given budget period, be used for short-term relief, or supplement existing funding sources, including Medicaid.
CMS is viewing the rural healthcare fund as an “opportunity to transform how healthcare is delivered in rural parts of the country,” Levinson said. “But the trade-off is that they’re really not focused on providing short-term, immediate relief to rural hospitals or other providers, and that means this fund is less targeted towards these more immediate concerns about rural hospitals closing their doors or eliminating certain service lines.”
Nearly half of Maine’s 24 rural hospitals are considered “at risk” of closing, according to an analysis by the Center for Healthcare Quality and Payment Reform. Labor and delivery units are often the first to go. Since 2015, 12 birthing centers in the state have closed.
Impact
The “One Big Beautiful Bill” is projected to slash Medicaid funding nationally by $911 billion and by nearly $3 billion in Maine over the next decade. Considering only rural areas, the law is estimated to cut $137 billion nationally.
That means the rural healthcare program could offset about 5% of the total estimated cuts to federal Medicaid spending and 37% of the estimated cuts in rural areas, according to a KFF analysis of the Congressional Budget Office’s estimates released shortly after the law’s enactment.
“It’s also worth noting that the reductions in Medicaid spending will become much more significant in later years after the rural health fund has started to dry up, and many of those cuts are permanent,” Levinson said. The rural healthcare program is primarily being distributed over a five-year period.
In Maine, $66 million of the state’s $190 million will go toward improving hospitals’ financial sustainability, such as $35 million for the Rural Hospital Efficiency Fund and regional planning activities, and $29 million for helping providers transition to alternative payment models.
The next largest share of the funding, $53 million, will go toward technology, including telehealth hubs and services, cybersecurity and Artificial Intelligence. The Hallowell-based MCD Global Health is leading this work.
Community care is another component of Maine’s approved plan, with $34 million going toward things like evidence-based practices, nutrition education, and school-based care. Another component is workforce recruitment and training, with $31.5 million obligated for rural clinical training, simulation equipment and workforce transportation, among other efforts.
With this work just beginning, Jeffrey Austin, president of the Maine Hospital Association, said it is too early to speak to actual impacts of the rural healthcare program. As for the overall effect of the “One Big Beautiful Bill,” Austin said, “We certainly have some concerns in the short-term that some cuts will absolutely materialize, but decades-long projections are something I avoid.”
Austin said there are “plenty of ways the federal government could help in the future,” including “no additional cuts.”