A LePage administration health insurance program that inspired a key component of the latest Republican proposal to replace the Affordable Care Act was only in place 18 months before being supplanted by President Obama’s health care law.

Critics say that wasn’t long enough to gauge its effectiveness. Supporters, meanwhile, say the program was working well at lowering premiums.

The Maine program, called the Maine Guaranteed Access Reinsurance Association, or MGARA, was superseded by the Affordable Care Act in 2013.

“We just don’t know how it would have done over time,” said Mitchell Stein, a Cumberland-based health policy analyst. Stein said MGARA may have helped lower premiums, but at the expense of allowing insurers to offer fewer health benefits to consumers. He said there were several other health insurance reforms that went into effect at the same time, also making it difficult to know the impact of MGARA.

Supporters, however, said MGARA was working well before the ACA took effect.

“It did have many positive effects right out of the gate,” said Joel Allumbaugh, a health policy analyst with The Allumbaugh Agency, an Augusta-based health industry consultant. Allumbaugh agreed that if MGARA had been in place longer, it would be easier to assess its success or failure.

Allumbaugh, who helped design MGARA, noted that the program was intended to work in concert with Maine law that mandated insurers provide coverage for people with pre-existing conditions.

In contrast, the current ACA replacement plan – called the American Health Care Act – would permit states to opt out of protections for people with pre-existing conditions. The U.S. House could vote on the replacement bill this week.

The American Health Care Act would in effect eliminate protections for patients with pre-existing conditions in states that opted out of mandating that coverage, jacking up rates for those who have chronic health conditions.

The American Association for Retired Persons projects premiums could be up to $25,700 per year by 2019 for some people with pre-existing conditions who purchase coverage under the AHCA.

Rep. Bruce Poliquin, R-2nd District, has yet to support or oppose the latest ACA replacement, but his spokesman noted that protecting those with pre-existing conditions is crucial.

“Congressman Poliquin is still thoroughly reviewing all proposals. He is ensuring there is coverage for those who have pre-existing conditions, like his own son, Sammy,” Poliquin spokesman Brendan Conley said in an email response to questions. Conley said Poliquin’s 26-year-old son has asthma.

Meanwhile, the Maine-inspired portion of the ACA replacement proposal is drastically underfunded in the House bill, and would have minimal impact on rates, critics say.

A reinsurance program aims to reduce costs for insurance companies – and their customers – by adjusting for the fact that some marketplaces have pools of sicker people that insurers are covering. Individual markets typically include pools with higher numbers of sicker, older people because young, healthy people often don’t purchase individual health insurance.

Vice President Mike Pence praised the Maine program as a success on NBC’s “Meet the Press” Sunday morning.

“We’re basically borrowing an idea from the state of Maine that has seen a significant drop in premiums for people on their health insurance because you take people that have pre-existing and costly conditions and put them into a high-risk pool,” Pence said on the show.

Adrienne Bennett, a LePage administration spokeswoman, said in an email response to questions that “it’s great that Congress is finally recognizing good policy in the states.”

“Maine is a leader in health care reform. Americans cannot afford their health plans and Maine’s innovative approach will help reshape the nation’s outlook on health care,” Bennett said.

Eric Cioppa, Maine Bureau of Insurance superintendent, said in a statement that MGARA worked because it was “simple” and its “rating plan is based entirely on the objective factors of age and geography.”

Stein said there’s nothing wrong with the structure of a reinsurance program like MGARA, but the key is how well it’s funded.

“In the end, it all comes down to how much money is put in,” Stein said.

Nationally, the AHCA would fund the Maine-like program to the tune of $15 billion over 10 years, plus states could draw from a $115 billion fund over 10 years that could be used for a number of programs, including reinsurance.

Critics, including Topher Spiro, vice president of health policy for the Washington-based Center for American Progress, said the amount devoted to reinsurance programs is a tiny fraction of AHCA funding, and would have little impact on rates.

Maine’s program, also known as an invisible high-risk pool, resulted in a rate increase of 1.7 percent in 2012 for Anthem individual policyholders, instead of a projected 20 percent increase had MGARA not been in effect, according to the Maine Bureau of Insurance. At the time, most people with individual plans in Maine had purchased an Anthem plan.

But critics of Maine’s high-risk pool say that to achieve lower premiums, Maine permitted insurers to offer plans with fewer benefits. For instance, Maine did not require plans to offer maternity care, a significant and expensive benefit used by many.

Stein said in any event, the subsidies from the federal government to help Maine residents purchase insurance on the ACA individual marketplace dwarfed what MGARA generated. LePage’s program redistributed money to the individual marketplace in Maine by charging a $4 per person, per month fee on individual and small- and large-group plans. Revenue generated from the $4 fees – about $20 million – was funneled to individual plans to reduce premiums.

In comparison, premium subsidies in Maine under the Affordable Care Act totaled more than 10 times as much – $262 million for premium tax credits for those earning up to 400 percent of the federal poverty limit.

Whether the latest Republican replacement plan will gain any traction is uncertain. A planned vote in March on the original replacement plan was scrapped after it failed to gain enough support in the House of Representatives.

Votes on the second attempt keep getting pushed back as moderates object.

Sen. Susan Collins, R-Maine, said she opposed the original House ACA replacement bill. The new bill moves further to the political right, while a replacement plan touted by Collins is a centrist proposal that conservatives have criticized. Maine’s Sen. Angus King, an independent, has so far opposed all ACA replacement plans.

Rep. Chellie Pingree, D-1st District, blasted the ACA replacement plan on the House floor last week.

“The latest iteration of TrumpCare still drops millions from their coverage, but will now make coverage worse and more expensive for those who can get it,” Pingree 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.”

Joe Lawlor can be contacted at 791-6376 or at:

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Twitter: @joelawlorph


Correction: This story was revised at 9:55 a.m., May 2, 2017, to reflect the correct name of the Maine Guaranteed Access Reinsurance Association. An earlier version of the story misidentified the group.