Democratic Senate nominee Troy Jackson and Republican Sen. Susan Collins. (Photos by Daryn Slover/Staff Photographer and J. Scott Applewhite/Assocated Press)

This is the first in an occasional series in which the Portland Press Herald will compare the policy plans of Maine’s major U.S. Senate candidates, Democrat Troy Jackson and Republican Sen. Susan Collins.

Access to healthcare is a perennial issue in Maine, the oldest state in the nation by median age.

One way to expand access has become particularly popular in Democratic circles: Medicare for All. During the Democratic primary for U.S. Senate, the idea often drew enthusiastic applause at town halls and other campaign events.

Democratic nominee Troy Jackson, a fifth generation logger and former state Senate president, has talked about how a lack of healthcare is part of what inspired him to run for office more than two decades ago. He supports the proposal, which would offer federally funded healthcare to all U.S. residents.

But Republican Sen. Susan Collins has criticized the idea as expensive and impractical — and something that would lead to increased taxes on middle-class families. With the national debt approaching $40 trillion, the federal government is already struggling to pay its bills. Expanding Medicare would be a massive new expenditure at a time of fiscal uncertainty.

Medicare for All is just one of the issues offering a clear divide for voters this fall in Maine’s closely watched Senate race — one that could help determine the balance of power in Washington, D.C.

The Medicare for All Act, sponsored by Sen. Bernie Sanders, I-Vt., would cover all U.S. residents by automatically enrolling people upon birth or establishing residency.

The federally funded insurance plan offered by Sanders would cover medically necessary services, including hospital visits, prescription drugs, mental health, substance use treatment, dental, vision, home- and community-based long-term care, gender-affirming care and reproductive care.

In short, that would mean a radical expansion of the American social safety net.

The bill would also prohibit cost-sharing with patients, except for prescription drugs. And it calls for full enactment within four years.

What would it mean for Maine?

Fewer than 10% of Mainers lacked private or public health insurance in 2024, according to the United Health Foundation — though that number likely ticked up after the expiration of certain Affordable Care Act tax credits last year.

Every uninsured U.S. resident in Maine would be covered under Medicare for All. The policy would also improve coverage for others who have high-deductible plans.

The newly eligible enrollees would join the roughly 400,000 Maine residents served by MaineCare, the state’s Medicaid program for low-income people, and the 380,000 Mainers over 65 or with specific disabilities who are served by Medicare in receiving federally supported healthcare.

An additional 58,500 Mainers had subsidized insurance through the Affordable Care Act as of March 2026. That’s a drop of nearly 10% from last year, largely because of cost increases and the expiration of the federal tax credits.

Where do the candidates stand?

Jackson said he supports the Medicare for All Act because it would allow people to access comprehensive healthcare without having to pay premiums or deductibles, or be forced into medical debt. It also would stop insurance companies from denying coverage to people so they can make a profit, he said.

“Healthcare is a human right. No Mainer should avoid the doctor, ration their medicine, or face bankruptcy because they got sick,” Jackson said in a written statement.

Collins’ campaign dismissed Medicare for All as a talking point.

“Troy Jackson doesn’t have a healthcare plan; he has a slogan,” campaign spokesperson Shawn Roderick said in a written statement. “Troy has no plan for how to pay the additional $28-$40 trillion this would cost over the next 10 years. And Medicare is already facing shortfalls starting in 2033.”

Collins’ campaign didn’t respond to questions about her healthcare plan. But her Senate website notes that the country’s healthcare system “requires substantial reform.”

Collins voted to preserve the Affordable Care Act in 2017. And last year, she voted against legislation that included an extension of COVID-era healthcare subsidies before ultimately supporting the subsidies in a standalone bill that did not pass. Collins argued the subsidies should be reformed, and should not be offered to higher-income earners.

How much would it cost?

Studies vary on the true cost of Medicare for All. While expanding coverage will certainly increase federal budgets, the expansion would result in some savings by easing administration and billing processes. Other savings could be found through negotiating prescription drug prices.

A 2018 study by the Political Economic Research Institute at the University of Massachusetts estimated that Medicare for All could result in a 19% reduction in overall healthcare costs, reducing fraud, administrative overhead and prescription drug prices. Better access to preventive care leads to better health outcomes, the group said.

But in May 2022, the nonpartisan Congressional Budget Office released an analysis concluding that a single-payer healthcare system would cost between $1.5 trillion and $3 trillion annually in additional federal subsidies by 2030. (That analysis was not specific to Sanders’ bill.)

The CBO also said the increase in demand for healthcare would surpass capacity, increasing unmet medical needs.

How would the government pay for it?

Jackson’s campaign said additional federal costs could be covered by taxing billionaires and corporations. Additional savings would come from eliminating insurance industry profiteering and by negotiating lower prescription drug prices, his team said.

Collins’ dismissed that approach as unrealistic.

“Troy is going to tell you that raising taxes on fewer than 1,000 billionaires in this country is going to pay for healthcare for 340 million Americans — that doesn’t even come close,” Roderick said. “Whether you agree with this idea or not, the reality is that it would immediately raise taxes on all working Americans.”

Who else has weighed in?

Physicians for a National Health Program is one of the leading groups advocating for Medicare for All. The group believes that healthcare is a human right and should be considered a public good, rather than a commodity sold at a profit. The group notes that countries with government-run plans provide the same services at a lower cost.

The Partnership for America’s Health Care Future, which includes pharmaceutical, hospital and health insurance lobbyists, opposes both Medicare for All and a public option that would allow people to buy into a government-run healthcare program. The group argues that it would lead to fewer options for patients and increase taxes on middle-class families.

How viable is the proposal in Congress?

Bills proposing Medicare for All have hit a brick wall in Congress time and again, raising questions about the idea’s viability even if Democrats regain control in Washington. (Republicans currently control both chambers of Congress and the presidency.)

Proponents have been trying to expand Medicare ever since it was first adopted in 1965. Although The New York Times first reported the term “Medicare for All” in 1970, it’s been pursued mostly as universal or single-payer healthcare.

Rep. John Conyers, D-Mich., regularly introduced Medicare for All bills from 2003-17.

Since then, Sanders has been a leading advocate. His most recent bill was introduced last year.

Several blue states, including California and New York, have also sought unsuccessfully to push for single-payer systems on their own. And activists in Maine are circulating a citizen initiative to direct state lawmakers to draft a plan for universal, publicly funded healthcare coverage by 2028.