At a press conference yesterday, President Donald Trump declared that his plan to repeal the Affordable Care Act “gets better and better and better, and it has gotten really, really good,” saying he expects a vote on the legislation next week.
The details of the modified plan are still a mystery, but it seems to rely heavily on eliminating consumer protections, allowing insurers to avoid covering certain health care services, and allowing them to charge higher premiums to certain populations.
Republicans in the White House and Congress have pointed specifically to Maine’s health insurance deregulation in 2011 as a model for these kinds of changes, and the Maine GOP has also taken up that call and have attempting to rehabilitate the failed Republican experiment of Public Law 90 (affectionately known to those of us who watched its passage and implementation as “the rate hike bill.”)
Talking Points Memo did a good job last week examining these claims, and found them to be false – the small reduction in premiums for some health plans was due more to the implementation of the Affordable Care Act a year later (and a new $4 per-plan-per-month tax given directly to the insurance companies) than stripping away the insurance regulations.
Basically, the rate hike bill allowed insurance companies to charge more for worse coverage, while giving them a new taxpayer-funded subsidy.
But even that analysis misses the full scope how terrible of an idea it was, both in terms of policy and politics.
First, while TPM does cite one publishing firm that experienced a 32% increase in their insurance costs, that was far from the worst result in the small business market. For posts on this blog and for a column I was writing for the Kennebec Journal at the time, I talked to business owners across the state who got hit even worse.
For just a few examples, Briggs Advertising in Bath saw their premiums increase by 67% after passage of the law and had to resort to layoffs. The Grasshopper Shop in Ellsworth saw their rates go up by 78% to more than $1,600 a month and were forced to cancel their coverage.
Reel Pizza, a restaurant and theater in Bar Harbor, saw their rates go up by more than 95% thanks to provisions that allowed insurers to charge more based on age and geography.
Despite a multitude of promises that the law would only lead to lower rates, in Eastern, Western and Northern Maine, more than 96% of businesses saw their premiums increase. Basically, as reports showed at the time, except for a few young, healthy people living in more urban areas and buying individual plans, the policy was a disaster.
The politics were pretty awful as well.
The bill was shoved through the legislature in a way that foreshadowed the current process for the federal health care repeal bill. The legislation was drafted in secret and rushed through the Insurance Committee and the legislature at breakneck speed, without allowing vetting or amendment.
GOP representatives on their way to vote for the legislation admitted on video that they hadn’t read and didn’t understand key provisions of the bill, the Republican House Appropriations Committee Chairman resigned in protest over the poor process and the Bangor Daily News dubbed the whole thing “a lesson in how not to lead.”
The impetus behind the legislation and its rushed passage became clearer in 2012 thanks to a report from Maine Citizens for Clean Elections, which tracked a massive shift in insurance company spending directly before and after passage of the right hike bill, with millions given to Republican candidates and PACs.
That fall, the voters had their say, and they weren’t happy with the health care changes. Despite the insurance company spending, Democrats won back large majorities in both the House and Senate, with many of them specifically running against the rate hike bill. Democrats like Geoff Gratwick, a doctor, and Colleen Lachowicz (now Colleen Madigan), a social worker, flipped Republican Senate seats in large part by focusing on the effects of the legislation.
So yes, national Republicans should look the the “Maine model” as they consider health care policy, but not as a success story. It’s an example of how industry-backed insurance deregulation can lead to poorer health care, economic hardship and electoral consequences.