Vice President Mike Pence went on NBC’s “Meet the Press”  to talk up a state health care reform baked into Republicans’ Affordable Care Act replacement plan. But our U.S. senators seemed split on whether that’s a good thing.

After their last replacement plan was pulled in March for lack of support, Republican leaders have made changes to the bill aimed at winning backing from conservative members.

One of those changes is a “high-risk pool,” which requires insurers to identify higher-cost patients — such as those who have pre-existing conditions or are older — and put them into a special pool where insurance is partially subsidized by the federal government.

It was one of the key pieces of Maine’s 2011 Republican health care reform law that was quickly usurped after the implementation of the Affordable Care Act. That has made Maine’s law — which loosened regulations on the insurance industry — hard to evaluate ever since.

Impacts were uneven: An actuarial analysis for the state in late 2011 said the law reduced premiums for 80 percent of people in the first year, but for the older and more rural patients, premiums went up because of provisions allowing insurers to charge more according to age and geography.

The conservatives who helped pass the Maine law have hailed it as a success and pitched it as a national model, but health policy thinkers in the center and on the left don’t like high-risk pools.

On “Meet The Press,” Pence said Republicans are “basically borrowing an idea from the state of Maine” to subsidize plans so “it is affordable to those individuals” who are higher-risk.

But the Kaiser Family Foundation says the pools haven’t worked well in states because of high costs and the left-of-center Brookings Institution is also skeptical that the $15 billion over nine years earmarked in the Republican plan would be even close to enough to be effective.

In a joint interview following Pence, Maine U.S. Sens. Susan Collins and Angus King seemed split on this idea. Collins, a Republican, said “it did work well for two years.”

But King, an independent who caucuses with Democrats, said “I don’t think it’s a panacea and I don’t think it necessarily is an easy answer to the dilemma” of replacing the Affordable Care Act’s protections for people who have pre-existing conditions.


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