MADISON (WKOW) -- As the U.S. Senate grapples with an age-old health care question - how to lower costs and still provide good coverage for everyone - Senator Ron Johnson (R-Wisconsin) believes the answer may lie in Maine.
"Well, the reality of the situation is that about 50 percent of the premium increase is caused by guaranteed issue," said Sen. Johnson. "So, that's the bad news."
"Guaranteed issue" is a technical term for guaranteed health insurance coverage, even to those with preexisting conditions.
Sen. Johnson contends that the fatal flaw of the Affordable Care Act is that it guaranteed health insurance to all without a way to make sure everyone else didn't have to feel the hit of rising premiums and deductibles.
Trying to stem those rising costs without pulling the rug out on the newly insured is Sen. Johnson's goal.
That's why he's loOKing to Maine in order to accomplish it.
"The instituted something called invisible high risk pools, literally cut those premiums in half," said Sen. Johnson.
Those pools are "invisible" because high risk patients don't even know they're in one.
They are able to sign up for any plan just like someone without pre-existing conditions.
"The idea is that health insurers would only pay for some of the medical costs for high-risk people who enroll in their plans, with a separate fund (the "invisible risk pool") picking up the remainder of those costs. That allows the health insurers to charge lower premiums because they do not need to raise the money to pay for all the costs for high-risk people," explained UW-Madison Professor Justin Sydnor, an expert on health insurance markets.
Bobby Peterson of ABC for Health, Inc. - a Madison-based advocacy group for the uninsured - said Sen. Johnson's idea "isn't the worst."
"The invisible risk pool could be ok as long as it's very well funded and supporting people with pre-existing conditions, and giving them the level of coverages and services that they need," said Peterson, who is a staunch supporter of the ACA.
But as Sydnor points out, the rest of that funding has to come from somewhere.
"So the key questions are, how will the tax money be raised to fund the "invisible risk pool"? and will the money collected for the risk pool be large enough to make a big difference?," said Sydnor. "In the case of Maine, their "invisible risk pool" was helpful but was not a large driver of lowering premiums there. The key problem is that in most cases the amount of money behind these outside pools is not significant enough to make a very big change on the market."
Maine also exempted maternity care from its mandatory coverage provisions, which contributed to those premium reductions as well.
Still, given some of the options to come out of Capitol Hill this spring, Peterson said it could be a workable alternative.
"It's better than an explicit high risk pool that people get segregated into higher cost care, waiting periods, more expensive treatments - that's the bad idea," said Peterson, who does not support Wisconsin returning to a such a plan, which was in place prior to the ACA taking effect.
Sen. Johnson's opinion matters more than most. He is one of 13 senators on the working group that's looking at either tweaking the American Health Care Act (AHCA) passed by the House, or drafting a health care plan of their own.
"I think it's very achievable to cover pre-existing conditions without sky-rocketing premiums, without collapsing these markets," said Sen. Johnson. "That's what we gotta work on."
And unlike House Speaker Paul Ryan, Sen. Johnson is in no hurry to get a plan to the Senate floor for a vote.
"I certainly want to take the time to be able to get it right," said Sen. Johnson. "What I don't want to see is a bill that's rushed through, where a vote is forced and we end up not fixing this problem."