As rural birthing units close across Maine, the Maine Beacon asked Maine’s Senate and 2nd District candidates about their plan to protect rural maternity care. Troy Jackson and Matt Dunlap answered. Sen. Susan Collins, who voted against the 2025 Medicaid cuts but provided a pivotal vote to advance the bill, and Paul LePage, who vetoed Medicaid expansion five times as governor, did not.
On Dec. 18, MaineHealth will close the birthing unit at Lincoln Hospital in Damariscotta. It is the 12th labor and delivery unit in Maine to close since 2015. Federal Medicaid cuts in Pres. Donald Trump’s One Big Beautiful Bill Act (OBBBA), which phases in over the next several years, could put more of Maine’s rural birthing units at risk (read more.):
The Maine Beacon sent written questions to the campaigns of Sen. Susan Collins and her Democratic challenger, Troy Jackson, and to the 2nd Congressional District candidates, Republican Paul LePage and Democrat Matt Dunlap. The questions asked what each would do to keep existing rural units open and staffed, where they stand on the 2025 Trump Medicaid cuts and whether they support two bills before Congress.
These bills are the Keeping Obstetrics Local Act” and the “Rural Obstecricts Readiness Act.”
The first, (S. 2059 in the Senate, H.R. 3942 in the House), would increase how much Medicaid pays hospitals for labor and delivery. MaineCare currently pays doctors about 70% of what Medicare pays for obstetric care, while hospitals absorb the difference. The bill would also send extra federal money to hospitals that average fewer than 300 births a year. Lincoln Hospital delivered 131 babies last year. Hospitals would have to give at least 180 days’ notice before closing a birthing unit. Sen. Ron Wyden (D-Ore.) introduced the Senate version in June 2025. It now has 22 cosponsors: 20 Democrats and two independents, Angus King of Maine and Bernie Sanders of Vermont. No Republican has signed on.
The second (S. 380) would pay for training, equipment and telehealth so emergency rooms at hospitals without a birthing unit can handle a woman in labor. Sen. Collins cosponsored the bill with Sens. Maggie Hassan (D-N.H.), Katie Britt (R-Ala.) and Tina Smith (D-Minn.). It passed the Senate health committee 21 to 1 in July. Maine hospitals alone are projected to lose more than $66 million a year from the OBBBA Medicaid cuts. Collins voted to open Senate debate on OBBBA in June 2025, then voted against final passage.
The Maine Beacon emailed questions to all four campaigns on Oct. 15 and followed up by email and phone on Oct. 20, 21, 23 and 27. The Collins and LePage campaigns did not respond.
Responses are published in full and unedited.
U.S. Senate
Troy Jackson (D)
The Maine Beacon asked Mr. Jackson the following questions:
- What is one specific policy you would champion to keep an existing rural labor and delivery unit open and staffed?
- Medicaid is a major payer for rural births and the 2025 One Big Beautiful Bill Act reduces federal Medicaid spending. What specifically would you do in the Senate to protect that revenue for rural hospitals with birthing units?
- You rallied against the Damariscotta closure in August. Would you cosponsor the Keeping Obstetrics Local Act (S. 2059)? It has no Republican cosponsors. How would you get it through a closely divided Senate? Do you support Senator Collins’s Rural Obstetrics Readiness Act?
Jackson: Rural Maine isn’t somewhere I visit when there’s an election. It’s where I’m from. I’ve stood with families fighting to save their birthing units because they know what losing them means. No one should have to wonder whether they can get to a hospital in time to have their baby.
In the legislature, I helped pass laws to fund rural hospitals and ambulance services. In the Senate, I will cosponsor the Keeping Obstetrics Local Act and fight for Medicaid payments that cover the cost of keeping rural birthing units open and staffed. A hospital still needs nurses, doctors, and equipment ready around the clock, regardless of how many babies are born that week.
I would also fight to reverse the Medicaid cuts in the Big Ugly Bill and restore the federal funding our rural hospitals depend on. Susan Collins voted to advance that bill despite knowing the damage its Medicaid cuts would do. She talks about her power in Washington. Mainers needed her to use it to stop those cuts. The rural health care fund is a band-aid on a gunshot wound.
Rural Maine needs a senator who will fight like hell to keep these communities alive, and that’s what I’ll do.
Sen. Susan Collins (R) did not respond. Here is what her record on healthcare shows:
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- Collins opened the door to Trump’s OBBBA. On June 28, 2025, Collins voted to begin debate on Trump’s budget bill and its Medicaid cuts, one of the largest cuts to health care in American history. The motion passed 51 to 49. Only two Republicans, Rand Paul (R-KY) and Thom Tillis (R-N.C.), voted to stop it.
- Final passage. Three days later, the bill passed 51 to 50 on Vice President JD Vance’s tiebreaker. Collins voted against it, citing the damage to Medicaid, rural hospitals and nursing homes. That same day, Maine nurses rallied outside Collins’ Portland office against the cuts.
- Rural health fund. Collins proposed an amendment to put more money into rural hospitals. It failed 22 to 78. The final law included a separate $50 billion rural health fund. However, Collins herself said it won’t make up for the Medicaid cuts. In March, a pro-Collins ad praised her for delivering the fund. At the time, none of the money had reached Maine.
- Emergency training for hospitals. Collins cosponsors the bipartisan Rural Obstetrics Readiness Act, which would train and equip rural hospitals to handle births after their delivery units close. The bill does nothing to keep existing units open. The bill guarantees as little as $2 million a year nationwide for the new training and only if Congress raises funding above current levels. Maine hospitals alone are projected to lose more than $66 million a year from Trump’s OBBBA Medicaid cuts, according to Third Way.
- On the closure of the birthing unit at Lincoln Hospital. Gov. Janet Mills, U.S. Rep. Chellie Pingree and all three candidates for governor urged MaineHealth to delay its vote on closing the Lincoln birthing unit. Jackson spoke at a rally to keep it open. Sen. Collins has yet to comment on the closure.
- Collins voted to confirm Robert F. Kennedy Jr. to run the Department of Health and Human Services, which is responsible for Medicaid. RFK Jr. was confirmed 52 to 48 on Feb. 13, 2025. Collins and Lisa Murkowski, the Republicans seen as swing votes, both backed him. Mitch McConnell was the only Republican to vote no.
2nd Congressional District
Matt Dunlap (D)
Maine Beacon: What is one specific policy you will champion to keep an existing rural labor and delivery unit open and staffed? I’m asking about units still open today.
Dunlap: In the immediate short term, the best thing we can do is reverse the GOP Medicaid (MaineCare) cuts from 2025. Nearly half of all births are covered by Medicaid, so these cuts have devastated maternity wards. In the longer term, Medicare For All will help keep healthcare affordable, particularly in rural areas where many struggle to get the care they need.
MB: Medicaid is a major payer for rural births. Do you support the Medicaid changes in the 2025 budget law as written? Would you cosponsor H.R. 3942, the House version of the Keeping Obstetrics Local Act, which would pay low-volume hospitals to keep obstetric units staffed?
Dunlap: The Medicaid cuts in the 2025 budget law were a disgrace. They are the largest Medicaid cuts in history at a time when healthcare is already unaffordable for too many Mainers. We have to reverse them. The Keeping Obstetrics Local Act is a good step in the right direction to fund rural hospitals, which face drastically different challenges from the rest of the country.
MB: MaineHealth ended labor and delivery in Belfast in April 2025 and voted in August to end it in Damariscotta. MaineHealth is a tax-exempt nonprofit. Should Congress require tax-exempt hospital systems to maintain services like labor and delivery as a condition of that exemption? The Keeping Obstetrics Local Act would require 180 days’ notice before a unit closes. Maine already requires 120. Is that enough?
Dunlap: I think a longer notice period is a good idea at minimum. In rural areas, the closure of a maternity ward is a much bigger deal than in more densely populated areas. People need to know that they won’t have to travel far to deliver their child. They need the safety of knowing they’ll have trained medical professionals ready and nearby to deliver their son or daughter when the time comes.
I also additionally want to draw your attention to the fact that as Gov. Paul LePage said “We definitely have too many hospitals in the state of Maine” in response to a reporter question about layoffs at Maine Medical Center. He also called the 2025 Medicaid cuts “the greatest thing that could happen to the Maine people.” He vetoed Medicaid expansion six times, and while he will likely brag about paying down the hospital debt, it’s important to remember that he also vetoed Democratic legislation that would have paid down the hospital debt and expanded Medicaid.
Former Governor Paul LePage (R) did not respond to our questions. Here is what his record shows:
- Vetoes on MaineCare expansion. As governor, LePage blocked Medicaid expansion again and again: a 2013 bill that paired it with paying hospitals, a standalone bill that fell three votes short of an override and a 2014 compromise he called “ruinous.” When voters approved expansion in 2017, he refused to carry it out and vetoed the money to pay for it.
- Vetoed birth control and cancer screenings. In 2014, LePage vetoed a bill to cover family planning under MaineCare. It would have given nearly 14,000 low-income women birth control, cancer screenings and well-woman exams. Lawmakers couldn’t override him.
- Hospital debt. In 2013, Democrats passed a bill to repay the $183.5 million the state owed hospitals and expand MaineCare. LePage vetoed it. He signed a repayment-only bill after lawmakers dropped MaineCare expansion. His campaign now says he paid off $750 million in hospital debt.
- “The greatest thing.” LePage said he would have voted for Trump’s budget bill, calling it “the greatest thing that can happen to the Maine people.” At the Oct. 1 debate, he said he wouldn’t expand Medicaid even if it meant fewer uninsured Mainers.
- LePage’s case for Medicaid. At the Oct. 15 debate, LePage said he never tried to get rid of Medicaid. The program would work, he argued, “if you reimburse the hospitals and the medical profession at cost.” As governor, he vetoed MaineCare expansion repeatedly. Now he backs Trump’s budget bill, which cuts federal Medicaid funding for the hospitals he says should be paid in full.
Paul LePage has called himself “Donald Trump before Donald Trump became popular,” and has said he and Trump are “one of the same cloth.” For more on LePage’s disastrous record as Governor, listen to our podcast series “Trump Before Trump”.
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