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Maine’s Republican senators, Olympia Snowe, left, and Susan Collins, walk on Capitol Hill in Washington. “They stand out in the Republican caucus in the Senate because of their pragmatism” and willingness to work with Democrats to resolve an issue, a congressional scholar said.

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Sen. Susan Collins arrives for a vote on Capitol Hill in Washington earlier this month.

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“Very often, it doesn’t take 51 or 60 senators to get something done in the Senate – it takes one senator. The one senator who is either the 51st or 60th vote (to break a filibuster). Susan Collins is often the one vote that determines if something happens or not. It raises up her influence in the Senate considerably,” said Sen. Joe Lieberman, I-Conn.

COLLINS ON HEALTH CARE REFORM

Susan Collins issued this statement after the Finance Committee's vote:

"There simply is no question that our nation's health care system requires substantial reform. The status quo of soaring health care costs, families struggling, millions uninsured, and health care provider shortages is unacceptable. Maine families and small businesses are paying ever higher premiums, increased deductibles and greater co-pays.

"Due, in large measure, to the efforts of Senator Olympia Snowe, who has worked tirelessly, the legislation passed by the Senate Finance Committee represents a substantial improvement over the costly and flawed alternative approved by the Senate Health Committee as well as the House bills.

"Nevertheless, the Senate Finance Committee's bill falls short of the goal of providing access to more affordable health care for all Americans. The goal of health care reform must be to rein in costs and provide consumers with more affordable choices. Yet, many individuals and families would be forced to pay more for their health care under the Finance Committee bill, and they would have fewer choices. Our health care reform efforts should give Americans more, not fewer, choices of affordable coverage options.

"This bill also could lead to onerous financial penalties for small businesses that are already struggling to provide affordable health insurance to their employees. As structured, the bill actually could discourage small businesses from adding more jobs.

"I am troubled that the legislation would cut nearly $500 billion from Medicare, which provides care for our oldest Americans and our most vulnerable citizens. These cuts would adversely affect the ability of Maine's hospitals and other health care providers to provide essential services to Medicare patients. Medicare, which is so critically important to our nation's seniors, is already in financial trouble. It should not be the piggy bank for new spending programs when revenues are needed to shore up the current program.

"Finally, I am disappointed that the Finance Committee did not focus more on cost containment, which should have been one of the most important goals of this bill. For example, the legislation contains no meaningful medical liability reforms to reduce frivolous lawsuits and reduce the costly practice of defensive medicine. The Congressional Budget Office estimates that medical liability reform could save $54 billion in health care costs over the next decade. And the bill should do more to reform the health care delivery system in ways that would curb costs and improve the quality of care.

"I share the goal of passing responsible health care reform and, working with members on both sides of the aisle who share these concerns, I am hopeful that many improvements will continue to be made to produce a bill that can achieve bipartisan support. Our goal should be legislation that protects affordable health care choices, safeguards Medicare, and reduces costs to the consumer and the taxpayer especially at a time when we simply cannot afford to pay more."

Monday through Saturday, a young Susan Collins would see her father head to work, running the family's lumber business.

He'd get a bit of time off late Saturday afternoon and on Sunday.

Each fall, the future senator and her brothers and sisters would join the entire community of Caribou in a single task, whole families working the potato harvest, getting the crops in before the frost, before the snow.

"Everyone in The County works hard; consequently, that's what we know," said Sam Collins, the senator's brother. "It's ingrained in us, it carries forward when we go to work in other parts of the state or the country."

That work ethic, supporters say, has become a defining trait of his sister's career in the Senate. Sen. Susan Collins has applied it to campaign finance reform, homeland security and countless other issues.

And now the issue is health care reform.

Passage of a controversial $900 billion health care reform package is the top priority for Democrats, and the starts, stops and politics have gripped the country. President Obama has the votes needed to overcome a filibuster in the Senate, but it's a fragile situation. If any Democrat, or either of the two independents, yanks his or her support, the package is stuck.

So centrist Republicans like Collins and her colleague, Maine Sen. Olympia Snowe, are again in the spotlight. Snowe, as a member of a group of Finance Committee senators working on a compromise bill, was able to get many of her concerns addressed through her pivotal role.

Now it's Collins' turn.

SMALL FIRMS, RURAL CARE A FOCUS

Since January, Collins said, she has had more than 150 meetings on health care reform. She's spoken with constituents, Republican and Democratic colleagues, and administration officials. She met recently with White House Chief of Staff Rahm Emanuel for about an hour – a meeting that included a 25-minute pop-in by Obama.

She's working the issue with a group of centrist senators that includes Lieberman; Snowe; Evan Bayh, D-Ind.; Mary Landrieu, D-La.; Blanche Lincoln, D-Ark.; Ron Wyden, D-Ore.; and Ben Nelson, D-Neb.

The Senate bill, said Collins, "needs substantial improvement."

How would she have voted were she on the Finance Committee, where the bill originated?

"I'm not sure what I would have done the Finance Committee bill is the best effort yet. I appreciate all the work that Olympia has done to improve the bill," said Collins. "It still falls short, in my view, of the approach we should be taking. It does not do nearly enough to rein in the cost of health care."

Still, said Collins, the bill represents the best work so far, and she thinks Congress should keep working toward health care reform. Moving forward, she's focused on improving the bill to ensure that small businesses aren't hurt by any reforms, and on looking at health care options for rural parts of the country.

She's been clear about what she sees as the bill's failings. She's concerned the bill could have the unintended consequence of increasing the cost of insurance for middle-income families that may not qualify for subsidies.

The bill imposes deep cuts in Medicare, said Collins, and she's worried that will cause problems for hospitals, home health agencies and others.

She's discussed the issue with her brothers, who run the fifth-generation S.W. Collins lumber company, as well as with other Maine companies, like Norway Savings Bank.

She's heard her brothers' frustrations as small business owners. S.W. Collins provides health insurance for its 60 employees. Sam Collins said his grandfather began offering employees health insurance, at a time when such a benefit was unusual. It picks up two-thirds, the employees pay the remainder.

But every year, the company has seen a major increase in its insurance costs.

"We're put in the position...