House Speaker Paul Ryan has come up with yet another amendment to tack on to Trumpcare, in what even Republicans are admitting is basically just for show. That plan is to create a new "risk pool" to cover all the people with pre-existing conditions who would be priced out of Trumpcare, based on the model of a program in Maine. "This amendment alone is real progress and it will help us build momentum on delivering on our pledge to the country," said Ryan. Which of course is isn't and doesn't.
[H]ealth care policy experts in Maine and in D.C. paint a different picture, telling TPM that not only was Maine's system not as successful as the lawmakers claim, but it was propped up by several other policies—including the Affordable Care Act itself, which the GOP is gunning to repeal.
A series of reforms passed in Maine, in addition to setting up the high-risk pools, allowed insurance companies to charge older people, small businesses, and people in rural areas much more for their health coverage. It also allowed the companies to sell skimpier plans with sky-high deductibles that did not cover things like maternity care and many prescription drugs. At the same time, the system depended on charging all Mainers $4 per month, whether they were insured through their employer or on the individual market, to help cover the costs of people in the high-risk pool. The GOP's national plan purportedly modeled on Maine does not include this crucial funding structure, and includes no funding at all after the first nine years.
And while the lawmakers singing the praises of Maine’s program and calling for a national version are correct that coverage expanded dramatically since its implementation, most of the credit for that goes to the ACA—which penalized those who did not buy health insurance and offered tax credits to many who did.
For what Republicans would like to see happen with insurance markets, it's perfect. Garrett Martin, the executive director of the Maine Center for Economic Policy explains that "It provided an opportunity for the insurance companies to underwrite much cheaper policies for younger, healthier people and jack up costs for older, sicker, people." Exactly how it should be if you're a Republican. That led to what you'd expect. "Premiums were really high and participation was really low," explained Gary Claxton, the vice president of the Kaiser Family Foundation. And for that, everyone who had private insurance paid $4 every month—funding that isn't even included in the Trumpcare amendment.
The numbers—taken completely out of context—for the Maine program look pretty good. In fact, Republicans say it "cut insurance premiums in half for older members and by a whopping two-thirds for those under 19 years old." Those numbers only came about because the Affordable Care Act came to be. Obamacare is "where the bulk of our growth in coverage was," Martin said. "To suggest it was a result of PL90 [the Maine law] is on its face laughable."
It's also pretty unlikely to be enough to resolve any of the ongoing Republican infighting over Trumpcare.