Secret To Maine’s Touted High-Risk Pool? Enough Money

The Maine legislature determined a high-risk pool for insuring patients with dear medical conditions, partly saved with a surcharge on all policyholders in a state.

J. Stephen Conn/Flickr

As a GOP health check moves to a U.S. Senate, many consumers and lawmakers worry that people who have pre-existing conditions can find affordable health coverage.

There are a series of strategies underneath consideration, though one choice touted by House Republicans borrows an thought that Maine used several years ago. It’s called an invisible high-risk pool — “invisible” since people in Maine didn’t even know when they were in it.

The module existed from 2012 until 2014, shutting with a appearance of a Affordable Care Act’s word exchanges.

The Maine pool warranted aloft outlines than many state high risk pools since it had a pivotal ingredient: adequate money.

“The problem is that in sequence to do a Maine indication — that I’ve listened many House people contend that is what they’re aiming for — it would take $15 billion in a initial year and that is not in a House bill,” Sen. Susan Collins (R-Maine) told Politico. “There is indeed $3 billion privately designated for high-risk pools in a initial year.”

Maine’s module worked like this: When a proprietor practical for health insurance, they had to fill out a questionnaire. If they had certain medical conditions famous to be costly, their focus was flagged for a high-risk pool. To consumers, it was seamless. They paid unchanging premiums and got a same arrange of coverage as any other enrollee in their selected health plan.

As Mitchell Stein, an eccentric health process consultant in Maine, explains it, a cost of these patients’ some-more dear health bills was paid by a nonprofit entity set adult by a state — a Maine Guaranteed Access Re-insurance Association, or MGARA.

The income to compensate for these high-cost patients came from dual sources: a word process premiums paid by patients within that high-risk pool, and a $4-a-month surcharge on all policyholders in a state.

This invisible high-risk pool was usually one partial of a incomparable health remodel law in Maine, Stein says, and that creates a straight-up comment of how good a plan worked difficult. But it’s “a good theory,” he says, “and can be an suitable approach to hoop these things.”

Eric Cioppa, superintendent of Maine’s Bureau of Insurance, agrees with Stein. “In Maine, for a duration of time it was operating, it worked unequivocally well,” Cioppa says.

Though usually in outcome for a brief period, Cioppa says, a invisible high-risk pool did keep costs down in a particular market, where Anthem was a largest insurer.

Without a invisible high risk pool, Cioppa says, Anthem would, by a possess estimates, have increasing rates some-more than 20 percent. Instead, a rates went adult reduction than dual percent.

But Steve Butterfield, process executive of a Maine-based advocacy organisation Consumers for Affordable Health Care, cautions that there was a essential aspect of Maine’s invisible high-risk pool that fueled a success: It was well-funded. The chronicle due in a House GOP health bill, he says, is not.

Drowning In A 'High-Risk' Insurance Pool, At $18,000 A Year

“An research that was finished on what this module would need showed that it would need $15 billion to $20 billion per year to have any kind of reasonable impact on premiums,” Butterfield says.

The GOP check does allot about $15 billion to $20 billion — though that is for roughly a full decade, not per year.

“One of a concerns,” Butterfield says, “is if a feds are going to put this in place and usually flog in a token volume of money, is it going to be adult to a states to collect adult a tardy — collect adult a tab, and compensate into this thing to make it work?”

Furthermore, Butterfield says, as a law stands now, underneath a Affordable Care Act, there’s no need for high-risk pools of any sort. The thought to use invisible high-risk pools is a resolution to a problem that a GOP health caring check creates. Right now people can buy word regardless of their health status, either or not they have a pre-existing condition. It’s a GOP check that would concede states to opt out of that Obamacare rule.

U.S. Health Care Wrestles With The 'Pre-Existing Condition'

“I don’t understand,” Butterfield says, “why it would be a good thought to, on a one hand, say, ‘Well, we’re disturbed about pre-existing conditions, so we’re going to chuck not adequate income during a problem we’re creating. At a same time, we’re going to concede word companies to assign ill people more.’ “

And a invisible high-risk pool, says Stein, is usually one tiny offer within a incomparable health bill.

“There’s zero inherently wrong with it,” Stein says, “but it doesn’t unequivocally repair all a other problems of a bill.”

Which, he says, embody cuts to Medicaid, and intensity changes to what have been, underneath Obamacare, a guaranteed set of essential benefits.

This story is partial of NPR’s stating partnership with internal member stations and Kaiser Health News.