The AHCA specifically allocates $15 billion in funding over nine years for states to establish (or reestablish) high-risk pools for people with pre-existing conditions. Proponents of these pools have pointed to Maine’s “invisible” high-risk pools, which operated between 2012-2014, as proof that high-risk pools can provide affordable health care to people with high medical costs.
From 2012-2014, Maine residents with certain pre-existing conditions who applied for insurance on the individual market were placed in an “invisible” high-risk pool. The pool was “invisible” because premiums were the same on the individual market for healthy people and people with pre-existing conditions. In order to fund the higher medical costs of people in the high-risk pool, Maine charged residents a $4 per-person, per-month tax on all health insurance plans.
Maine’s health insurance tax generated $21 million -- or about 12 - 15% of the actual cost of premiums on the individual health insurance market with high-risk pools. To raise revenues without raising premiums for people with pre-existing conditions, Maine’s largest insurer doubled out-of-pocket maximums and required 30% coinsurance from enrollees. Coverage for many basic services was dropped.
After the high-risk pools were implemented in Maine, more than half of people enrolled in the individual market faced rate increases. Small groups fared similarly poorly. In Southern Maine (the state’s most populous region), more than 80% of small businesses paid more for employee insurance. In Northern Maine -- one of the state’s most rural and impoverished regions -- almost a quarter of small businesses saw health insurance costs jump by more than 40%.
After high-risk pools were implemented in Maine, health care coverage for many individuals became markedly worse, with fewer benefits and more cost-sharing. While Maine’s program avoided many of the troubles faced by other state high-risk pools, including limited enrollment and long waiting lists, it was also funded at a level significantly higher than what the AHCA proposes.
The AHCA specifically allocates $15 billion over nine years to help states establish high-risk pools, with an additional $8 billion over 5 years to assist generally with premiums and cost-sharing for individuals with pre-existing conditions. In 2019, this would provide approximately $3.3 billion to fund all high-risk pools nationwide.
Senator Susan Collins of Maine, a proponent of the Maine model of high-risk pools, has said that the AHCA’s proposed level of funding would not be sufficient. "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," she told NPR.