Last week Senator Susan Collins (R-Maine) made her vote for the Senate tax reform legislation contingent, in part, on a promise by Senate Majority Leader Mitch McConnell that he would ensure a vote before the end of 2017 on two separate pieces of legislation she’s pushing that would, if enacted, stabilize the Affordable Care Act exchanges.

““Having secured these key improvements in the bill, as well as the commitments to legislation to help lower health insurance premiums, I will cast my vote in support of the Senate tax reform bill,” Collins said in a statement released Friday.

So how’s that working out for you, Senator Collins?

The latest bit of bad news for Collins comes from Avalere Health. According to an analysis the healthcare consulting company released this morning, the reforms sought by Collins, while helpful, are possibly “overshadowed” when the Senate tax bill’s repeal of the individual mandate is taken into account.

The basic problem is that according to the Congressional Budget Office, mandate repeal will cause premiums to spike. The two pieces of legislation that Collins is supporting would try to make up for this. One bill would give insurers $4.5 billion over the next two years to help compensate for the costs of covering sick – read expensive – patients, something known as reinsurance. The other bill would restore payments to insurers — which Trump had stopped — and which would cover the cost of insuring low income people, otherwise known as cost-sharing reductions, or CSRs.

Together, they are supposed to keep down premiums. Caroline Pearson, a senior vice president at Avalere, told The Hill that their study concludes that “From a premium point of view, we do think reinsurance and CSRs probably covers the mandate.”

But this remains unclear. Topher Spiro, a health policy analyst at the liberal Center for American Progress, points out that the analysis actually doesn’t support that conclusion, once you take account of the fact that Trump has already halted the CSRs; restoring them will merely return us to the previous status quo.

What’s more, a number of healthcare wonks recently told Vox that the second of these two bills will not do nearly enough to fix the spiking premium problem.

And finally, the actions sought by Collins only cover a two-year period, and Avalere’s own experts conclude that once they expire, they would do little to deal with spiking premiums. As Elizabeth Carpenter, a senior vice president at Avalere, put it: “Eliminating the requirement to purchase coverage would create additional uncertainty in the market. It is important not to overlook the negative impact of repealing the individual mandate on long-term market stability.”


Actually, this may be the second time Collins appears to be getting hosed. It’s starting to look like that deal Collins made with McConnell — who promised a vote on those two bills — wasn’t exactly solid either. The Hill reports:

Speaker Paul Ryan’s (R-Wis.) office told a meeting of congressional leadership offices on Monday that the Speaker is not part of a deal to get ObamaCare fixes passed before the end of the year, according to a source familiar with the meeting.

Last week, Collins received assurances not just from Senate GOP leaders of votes on the bills, but also from President Trump that he would support them.  She said she believed these would protect ACA enrollees from the impact of the rollback of the individual mandate.

But now the Senate and House bills will be merged in conference. And as noted above, Ryan is not even saying whether the House will support or oppose either of them.

It’s unclear, however, how much Collins will care about all of this. After all, she appears to really want to defend her vote for the tax bill — so much so, that she’s actively promoting rosy fiscal scenarios for the bill that don’t actually exist.

On Face the Nation, Collins claimed economists Glenn Hubbard, Larry Lindsey, and Douglas Holtz-Eakin said the tax cuts would set off a wave of economic growth that would more than make up for the tax cut’s impact on revenue and lower the debt. But Hubbard and Holz-Eaken promptly denied to Jennifer Rubin they ever claimed such a thing. “We told her that pro-growth policy mattered, would help people and would offset (but not eliminate) the static budget loss,” Holtz-Eakin said.

When called on it, a Collins office spokesperson responded, “Senator Collins did not mean to state definitively that the tax cut would pay for itself.”

In other words, never mind.

So what’s next? Will Collins vote for the bill in the end? I’d predict public hemming and hawing and expressions of “concern” from Collins — before she goes along and votes yes. After all, Collins made a deal with McConnell to support tax reform in return for quick movement on  legislation to stabilize the health care exchanges. That deal is looking weaker by the minute. Yet she doesn’t seem to mind that in the least. Why would this change?