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Can the Democrats Get Collins on Board?

What would it take to get Susan Collins on board with the health reform bill? After months of sending hot and cold signals about the bill, the Maine Republican made remarks yesterday that suggested she might be willing to support the legislation if certain amendments were put through. "I have made very clear I cannot support the bill as it is currently drafted and that there would have to be substantial changes, but I certainly hope that that will be possible,” Collins said after meeting yesterday with White House health reform director Nancy-Ann DeParle and HHS health reform director Jeanne Lambrew. And what are the types of changes that she’d like to see? Politico has some of the details:

raising the penalty on hospitals with high rates of hospital-acquired infections, changing the small business tax credit to prevent it from discouraging hiring and increasing wages and boosting the affordability of insurance.

Taken at face values, these ideas might not drastically roll back reform—in fact, some of them could help broaden its reach.

While Collins didn’t go into great detail about her proposals, there are signs of what she’s likely to put on the table. Under the Senate bill, hospitals with the greatest hospital-acquired infection rate would be subject to a 1% penalty under Medicare beginning in 2015; in addition to raising the penalty rate, Collins would reportedly propose moving start date two years earlier. The small-business tax credit is currently limited to firms with less than 25 employees and average wages of less than $40,000. Like fellow centrists Mary Landrieu and Olympia Snowe, Collins seems inclined to support expanding the credit to larger firms and raising the income threshold.

Finally, Collins didn’t specify how she’d boost affordability, leaving open a range of possibilities: it could mean improving subsidies for the middle-class, but could also mean scaling back the benefits insurers would be required to offer in the exchange—something that Snowe herself had pushed for. This wouldn’t be great: the “actuarial value” of insured expenses dropped from 65% in the Finance Committee to 60% in the merged bill, and a further reduction could mean that individuals would pay less in premiums but significantly more out of pocket.

On the whole, though Democrats might be willing to accommodate such changes if it means that Collins—and other like-minded centrists—are willing to support the bill. Collins’ concerns closely overlap with Landrieu and Snowe’s, and if the Senate leadership could bring them all along, it might not be necessary to get Lieberman or Ben Nelson, who would end up losing considerable leverage.

That being said, it won’t be easy to finance some of the changes that Collins is asking for, like an expanded tax credit, and she could easily end up balking if the financing provisions—or other changes to the bill—aren’t to their liking. And her support wouldn’t help with the public option, as she opposes both Snowe’s trigger and Carper’s opt-out proposals. And it wouldn’t make much of a difference in terms of the public plan, as Collins still opposes both the trigger and opt-out. But it could help Democrats in other areas, like abortion coverage: both Maine senators are pro-choice, whereas Nelson is planning to introduce a “Stupak-like” amendment. All told, the fact that another vote is back in play—and a Republican one at that—is a good sign for the Democrats and could end up giving them a wider berth as the debate moves forward.