Maine High-Risk Model Might Work If GOP Adds Funding

Last updated on 2017-06-29

One of the key components of the Republican health care bill (CBO score coming next week!) is funding for high-risk pools in states that choose to opt out of the Affordable Care Act’s protections for insurance policy holders with pre-existing conditions (like pregnancy and medical problems arising from rape).

Before the Affordable Care Act improved access to and quality of health care, Maine had an “invisible risk pool” that, for 18 months and alongside other reforms, helped people with pre-existing conditions keep their insurance. Alas, the GOP moved its ACA-repeal/replacement away from the Maine model in April. And even if GOP leaders move back toward Maine, they will need a lot more funding to make Maine happen:

“The problems is that in order to do the Maine model — which I’ve heard many House people say that is what they’re aiming for — it would take $15 billion in the first year and that is not in the House bill,” Collins told Pro’s Jen Haberkorn. “There is actually $3 billion specifically designated for high-risk pools in the first year. You could take some money form the patient stabilization fund. That money has a lot of claims on it for other uses” [Dan Diamond, “Susan Collins No Fan of ‘Maine Model’ as Patch for Health Care,” Politico, 2017.05.12].

Of course, we won’t need Congress and the states to scrounge up billions for high-risk pools if we just stick with the status quo:

…[policy director of the Maine-based advocacy group Consumers for Affordable Health Care Steve] Butterfield said, as the law stands now, under the Affordable Care Act, there’s no need for high-risk pools of any sort. The idea to use invisible high-risk pools is a solution to a problem that the GOP health care bill creates. Right now people can buy insurance regardless of their health status, whether or not they have a preexisting condition. It’s the GOP bill that would allow states to opt out of that Obamacare rule.

“I don’t understand,” Butterfield said, “why it would be a good idea to, on the one hand, say, ‘Well, we’re worried about preexisting conditions, so we’re going to throw not enough money at a problem we’re creating. At the same time, we’re going to allow insurance companies to charge sick people more’” [Patty Wight, “How Maine Got High-Risk Pools to Work,” PBS.org, 2017.05.17].

Hmm… spend a new ton of money to create multiple bureaucracies to fix a problem that only arises if pass a new law, or stick with the status quo and don’t create the problem in the first place. Funny—I’m feeling more conservative than Kristi Noem!