Whether Maine should expand its Medicaid program to cover tens of thousands more people has long been a hotly debated issue — and one that may be decided at the ballot box in November.

But until now, Republican U.S. Sen. Susan Collins has remained above the fray, focused on trying to come up with a national health care measure that could appeal to the American mainstream.

Over the weekend, though, Maine’s senior senator told The New York Times that she thinks her state should embrace a Medicaid expansion modeled on the one that Indiana adopted while Vice President Mike Pence served as its governor.

“I recognize that it’s not my call,” Collins said Monday. But, she said, the idea “is worthy of consideration in Maine.”

Indiana won approval for its variation in 2015 to require that low-income residents pay into savings accounts whose funds are applied to cover a portion of their insurance premiums. They also typically have co-pays that fall on their shoulders.

Collins said Indiana’s model has worked well, provided insurance to many who lacked it and delivered “a very high satisfaction rate.”

Its success, she said, is attributable to its ability to keep patients “vested in their health care decisions,” reducing the number unnecessary and costly emergency room visits and promoting more use of primary care doctors and urgent care centers.

If Maine decides to pursue the idea, Collins said, it would benefit from studying Indiana’s experience.

Pence once declared the expanded program focused on “respecting the dignity of every Hoosier, including our working poor, to find a way to cover themselves and their families, respecting their ability to make their own health care decisions and empowering them to lead better and healthier lives.”

Parts of Indiana’s expanded program aren’t all that different from what Gov. Paul LePage’s administration is angling to impose on Maine’s existing Medicaid program.

LePage is seeking to revise MaineCare to add asset tests, time limits and monthly premiums for some current recipients.

Among the things Indiana’s program does in addition is to provide coverage for people making up to 138 percent of the federal poverty line. Maine’s program only covers people who are below the poverty line.

At this point, there are 31 states that have expanded their Medicaid programs — nearly all of them without the tough standards Indiana added with President Barack Obama’s approval — and 19 that have refused to take advantage of the extra federal funding attached to the expansion.

Collins said another advantage of the managed care avenue that Indiana and some other states, including Ohio, have adopted is that if the House is successful in reducing payments for Medicaid, it won’t have as big an impact on those who rely on the program as it will for states with more open-ended programs.

Democrats are pushing to expand Medicaid in Maine along the same path that most states have followed. They’ve also spoken out against the sorts of restrictions Indiana includes.

Rep. Patty Hymanson, D-York, for example, decried LePage’s bid to alter MaineCare by calling the proposed changes “directly contrary” to the purpose of Medicaid.

“It creates unnecessary barriers that will ultimately restrict access, at a time when affordable and accessible health care should be expanding,” she said in a prepared statement.

The referendum slated for this year’s general election ballot would require Maine provide MaineCare services to those less than 65 years old — the age when Medicare kicks in — who have an income at or below 138 percent of the federally defined poverty level.

“The best way of ensuring health coverage and saving lives is passing the Medicaid expansion referendum on the ballot this November,” said Mike Tipping, who works at the Maine People’s Alliance and Maine People’s Resource Center and helped push for the public vote.

Tipping said Monday the ballot initiative is similar to policies already approved by large majorities in the Maine House and Senate, measures that Gov. Paul LePage vetoed.

Tipping said that in addition to providing health care for more than 70,000 more Mainers, Medicaid expansion would bring in $500 million in additional federal funds and “create more than 3,000 good health care jobs, predominately in rural areas.”

He said the extra help will also boost the efforts to deal with Maine’s opioid epidemic.

The Healthy Indiana Plan that Collins is eyeing includes more than simply finding ways to make low-income Hoosiers cough up a portion of the cost.

It also expands access to substance abuse treatment and offers benefits for those who quit smoking, follow chronic disease management programs and participate in other initiatives that seek to boost their overall health and fortunes.

Collins has introduced a health care proposal in the Senate along with Sen. Bill Cassidy, R-La., that seeks to carve out a middle ground on the issue by giving states more flexibility, including the right to leave Obama’s Affordable Care Act insurance exchanges in place.

It hasn’t gotten much traction on Capitol Hill, but it remains part of the discussion about possible alternatives to the House-sponsored Affordable Health Care Act whose impact would appear to be pretty dire if the Congressional Budget Office’s projections are valid.

Senate leaders are trying to craft a proposal that can secure enough votes to pass, but many senators have expressed doubt that it can be done anytime soon.

Collins, who has served in the Senate for two decades, is contemplating a possible gubernatorial run next year to succeed LePage, who is barred from the race because of term limits.

Sen. Susan Collins, R-Maine, a member of the Senate Appropriations Committee and the Senate Intelligence Committee, finishes a television news interview on Capitol Hill in Washington, Tuesday, March 28, 2017. (AP Photo/J. Scott Applewhite)
AP