Susan Collins and Maine's Rural Hospitals: What the Medicaid Cuts Cost Presque Isle, Ellsworth, Caribou and Calais

On June 30, 2025, Maine Senator Susan Collins voted against a motion to strike every Medicaid cut from the One Big Beautiful Bill Act and against a motion to remove its new Medicaid paperwork rules. Hospitals in Presque Isle, Ellsworth, Caribou and Calais were named as especially vulnerable to the cuts, which take federal Medicaid money out of rural Maine for ten years.

Collins voted to confirm Mehmet Oz and Robert F. Kennedy Jr., whose agencies wrote the Medicaid work rule that starts in Maine on January 1, 2027 and limited how much of the new rural health fund can be paid to hospitals. At an October 6, 2026 debate she said she let the bill reach the Senate floor so she could author the $50 billion fund, which falls well short of the rural cuts.

What It Cost: Maine's Rural Hospitals Under the Medicaid Cuts Susan Collins Voted Against Removing

• Rural Medicaid dollars. KFF estimates the law cuts federal Medicaid spending in rural Maine by $1.118 billion over ten years. Maine's first-year award from the rural health fund is $190 million, or $274 per rural resident.
• Hospitals at risk. Analyses by Families USA and Third Way project Maine hospitals will lose more than $66 million per year in revenue from the Medicaid cuts and identified Northern Light A.R. Gould Hospital in Presque Isle, Maine Coast Memorial Hospital in Ellsworth, Cary Medical Center in Caribou and Calais Community Hospital as especially vulnerable, Maine Morning Star reported.
• Closure warnings. An August 2025 Protect Our Care report listed Aroostook Medical Center in Presque Isle and Maine Coast Memorial Hospital in Ellsworth among hospitals at immediate risk of closing because of the Medicaid cuts, and a separate analysis found nearly half of Maine's 24 rural hospitals at risk of closing.
• Hospital budgets. Northern Light Health, whose flagship is Eastern Maine Medical Center in Bangor, estimated it will lose about $27 million in the first year of Medicaid cuts. MaineGeneral Health in Augusta estimated that 3,000 people in its service area could lose coverage, and its chief financial officer said, "We've had to make difficult decisions about what programs and services we can provide long-term".
• Coverage losses. About 86,000 members in the state's expansion group must show 80 hours a month of work, school or volunteering starting January 1, 2027. Reliance on the program is higher in northern Maine, where the at-risk hospitals are: About 34 percent of Mainers in the 2nd Congressional District are on Medicaid, compared with about 23 percent in the 1st District.

Susan Collins's Votes and Confirmations Behind the Medicaid Cuts Facing Maine's Hospitals

• Collins Voted Against Striking the Medicaid Cuts That Fall on Maine's Rural Hospitals in June 2025. On June 30, 2025, Susan Collins voted no on Senator Ron Wyden's motion to send H.R. 1 back to committee with instructions that would strike any provision that cuts funding for Medicaid. It failed 47 to 53. Under the law that followed, federal Medicaid spending in rural areas is estimated to decline by $137 billion over ten years, by KFF's estimate.
• Collins Voted Against Removing the Medicaid Paperwork Rules in June 2025. The same day, Susan Collins voted no on Senator Chris Coons's motion to remove provisions that strip people of federal benefits through new administrative burdens and paperwork requirements. It failed 48 to 52. The Medicaid work-reporting requirement it targeted is the law's largest Medicaid provision, and KFF's summary of Congressional Budget Office estimates says the law will reduce federal spending on health care by over $1 trillion over ten years. A Northern Light Health official told The Maine Monitor that people without coverage often delay their care and then go to the emergency department when their needs are more complex.
• Collins Voted Against a Funding Bill That Would Have Repealed the Law's Medicaid Cuts in September 2025. On September 30, 2025, Susan Collins voted no on S. 2882, a stopgap funding bill whose health title included a section titled Repeal of health subtitle changes, which would have undone the One Big Beautiful Bill Act's Medicaid cuts. It failed 47 to 53. The Medicaid cuts stayed in the law, and Maine's state health department still expects 31,000+ disenrollments in year 1 of the work requirements.
• Collins Voted to Confirm Mehmet Oz, Whose Agency Wrote the Medicaid Work Rule Taking Effect in Maine. On April 3, 2025, Susan Collins voted to confirm Mehmet Oz as administrator of the Centers for Medicare and Medicaid Services, and he was confirmed 53 to 45. His agency's June 2026 rule, which requires states to start the work requirements by January 1, 2027, projects that enrollment would be reduced by 2.3 million individuals in FY 2027.
• Collins Voted to Confirm Robert F. Kennedy Jr., Whose Department Capped How Much of the Rural Fund Can Pay Hospitals. On February 13, 2025, Susan Collins voted to confirm Robert F. Kennedy Jr. as secretary of health and human services, and he was confirmed 52 to 48. His department's rules for the law's Rural Health Transformation Program say states cannot exceed use of 15% of federal funding awarded for payments to health care providers, so most of each state's award cannot go to cover hospitals' losses.
• Collins Said She Let the Bill Reach the Floor to Author the Rural Fund; the Fund Covers About a Third of the Rural Cuts. At the first Maine Senate debate on October 6, 2026, Susan Collins said of her June 2025 vote on the motion to proceed to H.R. 1: "If I had not allowed the bill to go to the floor, I would never have been able to author the $50 billion fund to help rural healthcare". KFF found the $50 billion fund could offset a little over a third (37%) of the estimated cuts to rural Medicaid funding nationally.

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Last updated: 2026-10-25

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