In the upcoming midterm elections, voters are expected to register their frustration with Trump and their anxiety about the economy at the ballot box. Many strategists expect a Democratic wave. The increasing cost of healthcare has emerged as a key message in several of the year’s most competitive races.
This post is part of MurMur’s ongoing series on the 2026 midterm elections. Read the rest of the series here.
The Race
Maine’s Senate race is shaping up as a case study in that anxiety, with healthcare at its center. Susan Collins, 73, has represented Maine in the Senate for nearly thirty years and is seeking a sixth term. Her opponent, Troy Jackson, 58, a former president of the Maine Senate, became the Democratic nominee after Graham Platner withdrew amid misconduct allegations. Cook Political Report has rated the race as a toss-up.
Congress passed a sweeping law that has already hit ACA marketplace enrollees hard: premium payments for 22 million subsidized marketplace enrollees are set to more than double this year, and the Congressional Budget Office estimates the Medicaid and marketplace changes combined will leave 10 million more people uninsured by 2034.
What It Means in Maine
Some 58,000 Mainers who rely on the state’s ACA exchange for coverage have already experienced a 23.9 percent increase, with a likely increase of 14.8 percent next year. Maine’s health department estimates that 31,000 people could lose Medicaid coverage in 2027, the first year new paperwork requirements to verify employment take effect. Four Maine hospitals are at risk of closure because of the Medicaid cuts: Calais Community Hospital, Cary Medical Center, Northern Light Maine Coast Hospital, and Northern Light A.R. Gould Hospital.
The story Mainers are talking about is Lincoln Hospital’s maternity unit, closing this December, the twelfth rural birthing unit to shut in Maine since 2015. MaineHealth cites falling birth volume and OB-GYN shortages, not the new Medicaid cuts, as the cause. But a hospital already running on a thin margin has less room to absorb any new strain.
Congress did include a $50 billion fund to cushion rural hospitals against these cuts. Even so, Maine’s health department calculated that the state stands to lose $2.5 billion more from the Medicaid cuts than it will receive from the fund.
Collins’ Vote
Collins is known as a fierce independent, but her vote on this bill shows that has not truly been the case during Trump’s presidency. She voted to advance the legislation, which included the healthcare cuts described above, through an earlier procedural stage. According to critics, she voted against the bill’s final passage only after it became clear Republicans had the votes to pass it without her. It passed 51 to 50, with Vance casting the deciding vote. Voters will need to determine whether Collins did what she could to stop these cuts or was complicit in their passage.
Two Competing Approaches
Collins and Jackson both offer a response to the healthcare crisis, and the differences between their approaches say a lot about how each would govern. Collins favors a narrow, incremental fix within the existing system. Jackson favors extending Medicare to cover everyone.
With Ohio Republican Bernie Moreno, Collins has proposed reinstating the ACA’s enhanced premium tax credits, which expired at the end of 2025, for two more years, capping eligibility around $200,000 in income and requiring a minimum $25 monthly premium. Health policy analysts note the plan addresses only the marketplace side of the crisis, leaves the Medicaid cuts untouched, and could raise costs for the lowest-income enrollees under the new minimum-premium requirement.
Jackson’s plan is Medicare for All, a position that, by his own account, dates to why he entered politics more than two decades ago. His campaign says the cost would be covered by taxing billionaires and corporations, ending insurance-industry profit-taking, and negotiating lower drug prices. Collins’ campaign disputes the arithmetic directly, arguing that taxing fewer than a thousand billionaires cannot fund coverage for 340 million people. The fullest version of his plan, pairing a national Medicare for All system with a state public option as a transition step, comes from the platform he ran on for governor earlier this year.
Collins is proposing a patch to the existing system. Jackson is proposing to extend Medicare to everyone. The gap between those two approaches is what this race’s healthcare debate actually comes down to.
Sources
Congressional Budget Office, coverage-loss estimate for the reconciliation law (August 2025 detailed estimate)
KFF, premium payment increases for subsidized ACA Marketplace enrollees, 2026
Cook Political Report, Senate race ratings, September 2026
Bangor Daily News, fact-check of Democratic ads on Collins’ decisive-vote record, September 16, 2026
Portland Press Herald, comparison of Collins’ and Jackson’s healthcare positions, August 13, 2026
Maine Morning Star / MECEP, analysis of Medicaid cuts and the Rural Health Transformation Program, August 2026
STAT, reporting on the origin and shortcomings of the Rural Health Transformation Program, September 14, 2026
KFF Health News, on Maine’s reworked Rural Health Transformation Program allocation, July 2026
Maine Public / Bangor Daily News, coverage of the Lincoln Hospital labor and delivery closure, August 2026
NPR, profile of the Collins-Jackson race and Jackson’s “symbolic opposition” critique, May 2026