Last week, Gov. Paul LePage inadvertently expressed support for a Republican initiative to repeal and replace the Affordable Care Act, despite his contention that he’s “not interested” in it. The governor made the remarks during a radio appearance in response to a question about whether he supported Sen. Susan Collins’ proposed ACA replacement.

“No. Not at all. Not interested,” said LePage. “I think it should go to the states. I think each state should have its own program.”

In fact, Sen. Collins’ plan, dubbed the “Patient Freedom Act,” would allow states to craft their own health insurance policies by giving them the option of adopting their own version of the ACA along with all of the subsidies and mandates or allowing states to use federal subsidies for individual health savings accounts to pay health care costs, or simply developing their own policies without federal assistance. 

The governor said he would prefer to replace the ACA with Maine’s 2011 health insurance law, PL 90, which gave insurance companies more freedom to charge higher premiums to older and sicker Mainers in rural areas, while lowering rates for younger, healthier people.  

“I think what should be done is they should go to the states and say, ‘Look, come to Maine and say, PL 90 was working for you guys. You’re off the hook with the ACA and put PL 90 back in.’ I’d be happier than a lark,” said LePage.  

Individuals and groups that lobbied on PL 90  gave nearly $1 million in donations to legislative candidates and PACs during 2011, the year PL 90 passed, according to Maine Citizens for Clean Elections.  

It’s unclear how much more consumers will end up paying for health care under the Collins plan, as details are still sparse, but the amendment would eliminate the mandate that everyone buy insurance, which pays for the ACA. It would also retain some of the ACA’s provisions, such as prohibiting insurance carriers from putting lifetime limits on coverage and prohibiting discrimination based on pre-existing health conditions. The governor said that he supports mandating that insurance companies cover individuals with pre-existing conditions because people need to keep their insurance when they change jobs. 

“I think we should be going down a path of having a preventative care system that is mandated and then the [high deductible] catastrophic [insurance] should be out there and people should be buying the catastrophic,” LePage said. “Because if you do it that way, the cost of catastrophic is much, much less.”

The ACA does mandate that insurance plans cover preventative care, but individuals with high-deductible “catastrophic” plans, which often have lower monthly premiums, still have to pay up to $7,150 out-of-pocket per year for an individual and $14,300 for a family before full coverage kicks in. If the ACA were repealed without a replacement, approximately 95,000 Mainers would lose health insurance and costs to hospitals would increase by $475 million, according to Maine Center for Economic Policy. 

Although the governor supports abolishing the ACA, he has been promoting the ACA insurance marketplace as an option for the 5,800 young adults and 20,000 to 40,000 low-income parents he plans to cut from the MaineCare rolls in his budget. 

“I say you go to work and, frankly, if you’re an individual person right now and you make $9 an hour … you work 2,000 hours a year, which is the average work year, you are above the federal poverty [level] and qualify for the exchange,” said the governor in a  Jan. 26 radio appearance.  “So there should be no more uninsured in the state of Maine.”

Emily Brostek, executive director of Maine Consumers for Affordable Health Care, said the governor made an “interesting point” given the uncertain future of the ACA and the fact that LePage  has refused to set up a state insurance exchange. Currently, the federal government runs Maine’s insurance marketplace. She added that many low-income people are unable to work 2,000 hours per year to make it above the poverty level due to illness or the need to care for sick or aging family members. ACA subsidies are not available to people who are below the poverty level because the law was designed to cover those people with Medicaid, which Maine has not accepted. 

“Perhaps most important, people who are below the federal poverty line are not able to get help paying for insurance, and unless they are parents of minor kids or have a disability, they don’t qualify for MaineCare,” said Brostek. “He seems to be saying that the coverage gap doesn’t exist, and that just isn’t true. All that being said, I would 100% agree that there should be no more uninsured in the state of Maine.”