AUGUSTA — Gov. Paul LePage said Tuesday that he may try to create a state health insurance system to replace the Affordable Care Act after the failure of Republican leaders to repeal and replace the federal program that they say is collapsing.
“We are just going to withdraw the state and just go do our own thing,” LePage said. “The federal government obviously is broken so they are not going to stand in the way. They can’t get anything done.”
The governor did not provide details on how he would create a state health insurance system, but suggested it could be modeled on the state’s workers’ compensation insurance system or a law he and the Republican-controlled Legislature had enacted before the ACA launched in 2013.
Although states cannot entirely withdraw from the federal program, some of them have sought and received waivers that allow them to modify the program and customize their insurance markets.
LePage blamed his fellow Republicans for not repealing the ACA, and criticized President Trump for suggesting that Obamacare should be allowed to fail and collapse before Congress tries again to replace it.
Speaking with Ric Tyler on the Bangor-based WVOM radio station, LePage said letting the ACA fail under the weight of rising insurance premiums makes “no sense.”
“If you are telling people, ‘Let it fail so the American people can get hurt more, and when they get hurt more maybe we’ll do something,’ why don’t you go jump off a bridge? That’s just about as sensible,” he said.
LePage voiced his displeasure with fellow Republican governors and those in Congress who stood on the sidelines last week as Trump and House Speaker Paul Ryan withdrew their replacement bill, called the American Health Care Act. LePage at first opposed the replacement plan, but ended up supporting it after several amendments were made, including some that gave states more latitude to manage federal health care funds sent their way.
“I am very discouraged with a lot of Republican governors because they sat on the sidelines,” LePage said, calling himself one of the most conservative governors in the U.S. – or “arguably” one of the most conservative.
“And to have the Freedom Caucus sit on the sidelines and let the Democrats win, I honestly hope every single one of them gets defeated next year. There’s no difference between a Democrat and a Republican if you hide in the closet.”
POTENTIAL MODELS FROM STATE’S PAST
It was not immediately clear what LePage might propose for legislation to create a health insurance program at the state level, but he suggested he would model it after the state’s insurance system for workers’ compensation, which was created in 1993. The Maine Employers Mutual Insurance Co. was the result of a bill created under Republican Gov. John McKernan and resulted in a statewide insurance system for workers who sustain an injury on the job that leaves them unable to work.
Later Tuesday, during a news conference with Maine Department of Health and Human Services Commissioner Mary Mayhew to highlight proposed welfare reforms, LePage said he wanted to move Maine back to a system that he and the Republican-controlled Legislature enacted before the ACA took effect. That law, known as PL 90, set up a high-risk pool and subsidized the insurance with a fee on all individual health insurance plans in Maine. That law also loosened the rules on insurance carriers that sell coverage to the thousands of Maine companies with fewer than 50 workers – the so-called small-group market.
Conservatives argued that PL 90 was working and lowering insurance rates in Maine. But critics said it gave insurance companies too much latitude to raise rates for companies with older workers or those in rural, high-cost health markets, while lowering rates for younger, urban companies that tend to have lower health care costs.
“I predict it’s going to happen within my term,” LePage said. “That’s how imminent this is. I believe we are going to be forced … to start a health insurance company because nobody else is going to want to do the business in Maine.”
COVERAGE THROUGH HIGH-RISK POOLS
He said creation of that company likely would involve reviving PL 90 “because it showed promise, because we were lowering premiums and we were getting care for people in Maine.
“Right now (under the ACA), everybody has access but nobody can afford it,” he said.
Mayhew said after the news conference that the governor was optimistic about a PL 90-type program. “He believes strongly in what had been passed and the traction we were gaining in a very short window that it was in effect before the Affordable Care Act forced us to suspend it,” Mayhew said.
She said that state law was meant to insulate insurance companies to some extent by helping to cover high-risk pools of people. “Maine saw incredible success and that model is absolutely gaining interest in Washington,” Mayhew said.
When asked if Maine could set up a model program that others might follow, Mayhew said she didn’t think that would happen without the ACA being repealed.
Mayhew said she and LePage had not discussed what a state health insurance system might look like if Maine were to “do our own thing,” as the governor suggested.
Trish Riley, executive director of the National Academy for State Health Policy, said the LePage administration may be looking at seeking a waiver from the Trump administration that would allow Maine to use federal funds coming to the state under the ACA in a more flexible way.
“The Trump administration has signaled they will be more open to state innovation, so maybe (LePage) is thinking about taking the ACA and doing something differently,” Riley said.
She said if Maine expanded Medicaid under the ACA – something LePage has repeatedly blocked – the state might be able to request a waiver along the lines of the one Indiana has that allows it to use ACA funds to purchase private insurance for childless adults with low incomes while requiring them to share the cost of medical care and premiums.
DIRIGO HEALTH HAD MIXED RESULTS
Other provisions could include discounts on co-payments for those who quit smoking or join fitness programs, which is similar to what private insurance plans offer as a way to drive down the cost of health care. Riley said Alaska is seeking a similar waiver under the ACA.
Riley served as director of the Governor’s Office of Health Policy and Finance under former Gov. John Baldacci, a Democrat. She is widely considered the architect of Dirigo Health, a state-run health insurance system under which the state purchased health insurance policies for low-income Mainers before the advent of PL 90 and the ACA.
Dirigo Health also was anchored to an expansion of MaineCare, the state’s Medicaid program, that has since been rolled back under LePage. It had large cost overruns that exceeded projections, and conservative lawmakers said it left the state indebted to Maine hospitals and did little to lower private insurance premiums.
In 2010, during his first campaign for governor, LePage vowed to dismantle Dirigo Health, much as President Trump promised to repeal the Affordable Care Act during his campaign. Riley said LePage’s current position on not dismantling the ACA without a proper replacement is likely a result of his experience trying to dismantle Dirigo Health.
“When he ran for office his goal was to kill the Dirigo program. On Day 1 he was going to eliminate Dirigo,” Riley said. “But when he came into office, he realized that lots of Mainers and many small businesses were participating in the program, so he kept it going. He didn’t expand it, but he kept it going.”
Scott Thistle can be contacted at 791-6330 or at:
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