WASHINGTON — The lobbying frenzy began late last month, as senators and the White House desperately sought a way to pay for a high-stakes, high-profile infrastructure deal. One of their options: raiding $44 billion that had been set aside to help hospitals, nursing homes, and other providers recover from the pandemic, but was never spent.
Providers panicked — until Sen. Susan Collins stepped in to save the funds.
It’s not typical for a Republican lawmaker to actively defend the hospital industry. But Collins’ move was the latest in a growing string of pro-hospital moves from the Maine Republican, a moderate with a longstanding interest in health care. Her efforts to save the provider funding, which haven’t been previously reported, follow earlier efforts to secure Covid-19 relief funds for the industry and to lobby the Biden administration to get the money out the door.
“She’s been a champion of putting more dollars in the Provider Relief Fund, going back to the creation of the fund,” said Maggie Elehwany, the senior vice president of public affairs at senior living company Argentum. “She has a strong footprint and I believe feels very protective of it, which is greatly appreciated.”
And Collins will only become a more influential power broker for providers as her influence grows next Congress. If Republicans take control of the Senate after the 2022 midterms, she will be in line to chair the Senate Appropriations Committee, which holds the purse strings of the federal government. Even now, as a moderate willing to negotiate with Democrats, Collins holds outsize leverage within the upper chamber.
“When those numbers are tight, she is going to be in play on anything important,” Maine Hospital Association President Steven Michaud said. “If political numbers change, if she did become chair, well, obviously, it just grows then.”
In many ways, Collins is an ideal ally for senior living providers and hospitals. Her home state of Maine has the highest proportion of residents over age 65 in the country. MaineHealth, the states’ largest health care system, is also the state’s largest private employer.
Maine also has a significant population living in rural areas, where hospitals have been squeezed for years. Collins herself hails from the northernmost county in the United States, from a town called Caribou with a population of fewer than 8,000 people.
Collins’ deep interest in health care stems from astutely knowing her constituents and her state, said University of Maine political science professor Mark Brewer, as Maine’s population of older adults is even more inclined to be interested in health care than other states’ might be.
“For a lot of those people, they spent their younger years doing pretty hard manual labor in industries that don’t exist as much anymore, and they are going to need more care than, say, an elderly college professor,” Brewer said. “They were in the woods logging, working at paper mills, and hauling lobster traps.”
Collins has been interested in health care for her entire Senate career, stakeholders and analysts said. Brewer recalls Collins talking about the importance of research funding for diabetes in her first reelection race in 2002. She also led the Senate Special Committee on Aging for six years.
And, most notably, she held her ground in an incredibly high-stakes fight to kill Republican efforts to repeal the Affordable Care Act in 2017, in partnership with Sen. Lisa Murkowski (R-Alaska) and the late John McCain. Hospitals lobbied hard to protect the ACA because its coverage expansions have been hugely beneficial to hospitals’ finances.
“What I have seen is that she is willing to put her own career at risk to do the right thing for the people of Maine, and she has a very strong bent toward rural life and health care,” said Peter Wright, the president of two rural hospitals in the Central Maine Healthcare system.
She continued that advocacy throughout the Covid-19 pandemic. Last December she pushed to re-up the Provider Relief Fund in a government funding package, and this spring she partnered with Sen. Joe Manchin (D-W.Va.) in a push that resulted in $8.5 billion in additional funds for rural health providers.
When the possibility of raiding Covid-19 relief funds emerged as a possible way to pay for infrastructure projects last month, nursing homes and assisted living facilities panicked. They had expected to receive $10 billion of the remaining funds, and that couldn’t happen if the funds were drained.
In an unusual move, the American Health Care Association, LeadingAge, Argentum, and the American Seniors Housing Association banded together to lobby lawmakers and developed a social media ad campaign with slogans like “Seniors Over Sewers” and “People Over Pavement.”
One senior care lobbyist said the groups were nervous about getting through, as there were a multitude of industries pushing for changes and there was enormous pressure for negotiators to get a deal.
The senior care groups have had Collins’ ear throughout the pandemic, and she also co-led a request with Sen. Kyrsten Sinema (D-Ariz.) in April imploring Health and Human Services Secretary Xavier Becerra to release more money for facilities besides nursing homes that care for seniors, which were shut out of early rounds of relief payments.
“The pandemic has taken an enormous toll on our health care providers, particularly long-term care facilities and rural hospitals, and we cannot ignore the financial realities they face,” Collins said in a written statement. “As a lead negotiator of the bipartisan infrastructure package, I strongly opposed attempts to curtail this funding that has been a lifeline during the pandemic for hospitals, nursing homes, assisted living facilities, and physician practices across the country.”
Collins wasn’t alone in defending the Provider Relief Fund — Sinema, Manchin, Senate Finance Chair Ron Wyden (D-Ore.), and Senate Majority Leader Chuck Schumer all opposed using provider funds to pay for infrastructure too, lobbyists and Senate aides said.
The defenders of providers’ grant money also had another important factor working on their side. The Delta variant has led to an increase in Covid-19 cases and hospitalizations across the country, and the Centers for Disease Control and Prevention pivoted to more conservative mask guidance the day before details of the bipartisan package emerged.
The Delta variant threw a curveball to health care facilities that had just begun seeing pre-pandemic volumes return, Wright said. Wright praised Collins as a lawmaker who deeply understands the complex business of hospitals and remains accessible.
“We’re a relatively small state, and she is in a very influential and powerful position in Washington,” Wright said. “You can call her office and someone answers the phone, and I doubt Mitch McConnell or Nancy Pelosi’s constituencies can do that.”
Several other health care providers in Maine feel the same way. MaineHealth, the state’s largest health system and largest private employer, also stays in “constant contact” with Collins’ office, said Chief Government Affairs Officer Katie Fullam Harris.
When details did officially emerge, providers breathed a sigh of relief that their funding had remained untouched.
“She has a lot of priorities, so one never knows for sure, but we knew she was pushing hard for us,” the Maine Hospital Association’s Michaud said. “We were very pleased, and we knew who got the credit on that.”