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

The Maine legislature established a high-risk pool for insuring patients with expensive medical conditions, partly funded with a surcharge on all policyholders in the state.

J. Stephen Conn/Flickr

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

There are a number of strategies under consideration, but one option touted by House Republicans borrows an idea that Maine used several years ago. It’s called an invisible high-risk pool — “invisible” because people in Maine didn’t even know when they were in it.

The program existed from 2012 until 2014, closing with the advent of the Affordable Care Act’s insurance exchanges.

The Maine pool earned higher marks than most state high risk pools because it had a key ingredient: enough money.

“The problem 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,” Sen. Susan Collins (R-Maine) told Politico. “There is actually $3 billion specifically designated for high-risk pools in the first year.”

Maine’s program worked like this: When a resident applied for health insurance, they had to fill out a questionnaire. If they had certain medical conditions known to be costly, their application was flagged for the high-risk pool. To consumers, it was seamless. They paid regular premiums and got the same sort of coverage as any other enrollee in their chosen health plan.

As Mitchell Stein, an independent health policy consultant in Maine, explains it, the

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