As Republicans scramble to try to come up with a successor to the Affordable Care Act, or at least an alternative that can win over a majority of the GOP-controlled House, many are looking to Maine for a possible model.
In recent days, they’ve been talking about the high-risk pool established in Maine to provide insurance for its sickest residents as a possible path forward.
The thing about paths, though, is that while they typically lead somewhere, it’s not always where you want to go. Maine’s experience offers ammunition both for GOP leaders eager to replace Obamacare and for critics who say it’s not the right solution.
Either way, it’s clearly getting a lot of attention in the nation’s capital.
Vice President Mike Pence said on television last weekend that Republicans “are borrowing an idea from the state of Maine that has seen a significant drop in premiums for people on their health insurance.”
U.S. Sen. Susan Collins, a Maine Republican, said she’s been talking about the program with House moderates.
And Gov. Paul LePage touted the program Tuesday on Fox News by claiming the “very important” program is successful in Maine.
“If you go to the high-risk pool and let that work out like it did in Maine, I think everybody’s going to be surprisingly satisfied with what’s happening,” the governor said. “Premiums will go down, more people will get insured, and the system works.”
But not everyone is convinced.
“There are a lot of people in Maine who argue that there were limitations, that a lot of the coverages were dropped, and that expenses for older people over 60, for example, went way up,” U.S. Sen. Angus King, a Maine independent, said on “Meet The Press” on Sunday.
What Maine did in 2011 was to create a system that subsidized the cost of providing health insurance for those most likely to require lots of medical attention. It protected insurers from getting clobbered if they enrolled high-risk people, which had the effect of guaranteeing coverage for everyone and holding down rates for most consumers.
What makes it hard to judge its effectiveness is that it only operated in 2012 and 2013, apparently without a hitch, and then officials suspended its operations because the ACA marketplace replaced it.
On its face, the program appears to have done most of what its proponents hoped.
The Maine Guaranteed Access Reinsurance Association, a quasi-governmental nonprofit, operated the pool with funding that came from charging everyone with insurance $4 a month, basically hitting up most everyone for a little extra to cover the tab for Maine’s sickest.
In the time it was up and running, people who sought health insurance in the state filled in a questionnaire about their health. Their answers led the state to put some into the high-risk pool because they had medical issues that might prove costly.
What made it unique, however, was that patients never knew they were in the high-risk pool. It simply covered them without forcing premium increases or policy revisions.
Most other states — about 35 of them — with high-risk pools explicitly put their sickest residents into them rather than into the regular insurance pool. They typically charged at least 25 percent more for the insurance, as well, and in many cases had long waiting lists to participate in them, a consequence of shortchanging the funding.
Maine’s system proved successful in part because it had sufficient funding. It still has $5.4 million in its coffers, even though it’s not operating and is slated to cease to exist at the end of the year.
In its annual report this year, the nonprofit said it paid out $66 million in claims during its 18 months of operations. It also brought about a 20 percent decrease in rate requests once it began.
But a 2012 study from Consumers for Affordable Health Care said the data are misleading because the savings went entirely to younger people while those over 40 generally saw increases in what they had to pay.
Between the state program and the federal transitional reinsurance program that succeeded it, Maine’s individual health insurance grew much more stable, the association’s report said, with annual increases of 4.6 to 6.2 percent instead of the 10.9 to 16.7 percent yearly hikes in the years before they went into effect.
As a consequence, it said, “Maine’s current individual health insurance market is very different than it was in 2011” when lawmakers created the program. At the time, Maine had two health insurers for the individual market and most people could only afford high-deductible plans.
There were 35,000 people covered, it said, “many of whom were in poor health.”
Now, however, there are four carriers and more than 87,000 individuals who are covered, with maximum out-of-pocket annual costs of no more than $7,150 per person or $14,300 per family, the report said.
The report warned that repealing the ACA without doing anything else would lead to big problems.
If Obamacare is shelved, as many Republicans have called for, Maine’s individual health insurance market “would likely become unstable” unless the state reactivates the suspended program, it said.
“If healthy people, who were no longer required to purchase coverage or pay a federal income tax penalty, exited the market the experience would deteriorate and rates would rise. This could lead to a new death spiral where an increasingly unhealthy and shrinking block of covered persons were priced out of a market with fewer carriers and coverage options,” it warned.
Details of the proposed Affordable Care Act in the House are still tough to come by. It isn’t clear whether it will ever come up for a vote because leaders may abandon it if they can’t put together a coalition willing to pass it.
It also isn’t known whether the Republicans are ready to require other policyholders to pay more to fund a high-risk pool the way Maine did or to find some other way to direct enough money to the pools to make them functional. Many GOP legislators are averse to imposing anything that looks like a new tax.
“It’s all in the details, because what is being proposed doesn’t have the subsidy, for example, to make the Maine high-risk pool successful,” King said.
U.S. Rep. Bruce Poliquin, the Republican from Maine’s 2nd District, is a key figure in the equation because he has not taken a stand on the measure.
His spokesman pointed out that “it appears the latest proposals incorporate the success of Maine’s risk pool system, a Maine-based bipartisan solution.”
And one of the new bill’s chief proponents, Rep. Greg Walden, R-Oregon, told reporters it is based in part on “a great model coming out of the state of Maine where it has decreased premiums and increased enrollment.”
But even if it passes the House, its prospects in the Senate are even less rosy.
Democrats vow to fight it.
U.S. Rep. Chellie Pingree, a Democrat from Maine’s 1st District, said the new version of TrumpCare is even worse and more costly than the first failed version.
“I believe all Americans deserve protections for the coverage of essential health services and pre-existing conditions, not just members of Congress,” she said. “Swiss-cheese insurance plans that don’t cover ER visits or prescriptions and charge more if you have ever been sick aren’t worth the paper they’re printed on.”
scollins@sunjournal.com
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