In the debate over replacing the Affordable Care Act, Rep. Bruce Poliquin of Maine, R-2nd District, brought up his asthmatic adult son, Sammy, and the importance of protecting people with pre-existing conditions.

“My own son has an asthma condition, a pre-existing condition,” Poliquin said in a statement Thursday. “I’ve seen health care up close. We need to do the best job we possibly can when it comes to health care so Maine people get the care they need.”

But the American Health Care Act – the Republican House bill approved 217-213 Thursday – would result in millions losing health care coverage, and it undermines protections for pre-existing conditions.

The act also exempts Congress and congressional staff members from the provisions that weaken pre-existing conditions, effectively shielding them from the kinds of risks to which their constituents are exposed.

A separate bill approved unanimously by the House on Thursday would undo those congressional exemptions. However, that bill would be subject to a Senate filibuster and its future is uncertain.

The American Health Care Act weakens coverage by permitting states to opt out of federal laws that forbid insurance companies from charging patients more money for having a pre-existing condition.


To ease the impact on consumers, Republicans added $8 billion to a national pool of funds that would help subsidize premiums for people with pre-existing conditions.

Poliquin, Vice President Mike Pence and other proponents of the bill have noted that Maine provided a model for this approach with a so-called “invisible high-risk pool” that Maine implemented briefly before Obamacare passed. The pool in Maine was funded by a monthly tax on every insurance policy sold in the state.

Critics, however, maintain that the new House bill allows insurers to raise rates on people with pre-existing conditions to the point where they will not be affordable. They say that even with the addition of the $8 billion, the national pool would cover only a fraction of people who have pre-existing conditions and are purchasing coverage in the individual marketplace.

How many states will choose to opt out of pre-existing conditions standards and create some sort of risk pool is unclear, but if insurance companies were allowed to charge for pre-existing conditions, patients who had those conditions would be paying thousands more per year on their premiums – even with a subsidy.

The Center for American Progress, a left-leaning Washington think tank, estimated that someone with asthma would pay a $4,200 per year surcharge, $17,000 for pregnancy, $26,000 for rheumatoid arthritis and $140,500 for cancer.

“If you have to pay $100,000 for your premium, that’s not really access to health care,” said Sen. Angus King of Maine, an independent.


An Avalere Health study released Thursday revealed that a high-risk pool set up by the AHCA would not come close to having enough funding to cover people with pre-existing conditions.

“If you can charge sick people whatever you want, that’s effectively denying people coverage,” Linda Blumberg, a senior fellow at the nonpartisan Health Policy Center at the Urban Institute, told Consumer Reports this week.

Members of Congress and their staff would be exempt from the pre-existing condition surcharges if the AHCA is approved, and the bill that would undo the congressional exemptions fails.

Poliquin’s son, who is 26, has aged out of the provision in the ACA and the American Health Care Act that allows young adults to be covered under their parents’ plan.

Poliquin, a developer and former Maine state treasurer who was once a Wall Street financier, pointed out that Maine passed laws before the Affordable Care Act went into effect that required insurance companies to cover patients with pre-existing conditions, so states have always had the ability to protect their residents.

Members of Congress and their staffs now buy Affordable Care Act insurance on the individual marketplace. Most would earn too much to be eligible for subsidies that reduce premiums for those who earn up to 400 percent of the federal poverty level.


However, the federal government pays 72 percent of the ACA premium costs for lawmakers and their staff. That means a typical policy would carry a premium of about $100 to $200 per month, per person.

“The Republicans had to be tone deaf to include that in the original bill,” U.S. Rep. Chellie Pingree, D-1st District, said of the congressional exemption. “I don’t think any member of Congress would want to be covered under this health care plan.”

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

[email protected]

Twitter: joelawlorph

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