Want a government program to work? Be prepared to pay for it.

This just in: if you don’t adequately fund a program, it is not going to work. And in other news, water remains wet and Generalissimo Francisco Franco is still dead.

Chevy Chase made that last line famous on the first season of “Saturday Night Live,” and with good reason. It lampoons the breathless media coverage surrounding … well, everything. Like we saw first-hand last week with the passage of the American Health Care Act in the House of Representatives.

Now, the AHCA, as our acronym-addicted overlords in Washington have deemed it, is far from perfect. Which is exactly why we have a second body in Congress, the Senate. In the volley between the upper and lower chambers, they have an opportunity to sand off hard edges and come up with the best solution. Our own Sen. Susan Collins has an important role to play there, as does Maine’s experience.


Republican lawmakers celebrate passage of the American Health Care Act at the White House on May 4.

One of the core ideas in the AHCA is the establishment — in all 50 states — of “high-risk pools,” a critical component of the GOP-led reforms to Maine’s insurance market back in 2011. These “pools” can operate in myriad ways, whether directly accessed by individuals or “hidden” in the regulatory environment where policyholders never see it, among others. And they can work: according to Maine’s Bureau of Insurance, creation of an invisible high-risk pool “resulted in about a 20 percent reduction in requested rates.”

Yet, in the zeal to inflame passion against the AHCA, opponents took aim at the very idea of “high-risk pools.” Why? Because some states have failed to fund them appropriately in the past.

Although, if that is the standard, then we can declare Medicaid a failure. After all, the expansion of MaineCare under Gov. John Baldacci left the state over $500 million in debt to our hospitals. And elsewhere in our nation, the expansion of Medicaid contained in the Affordable Care Act — or ACA, or ObamaCare — is busting state budgets. At the federal level, the cost of that expansion was 50 percent higher than Obama administration estimates.

You see where this is going? Any program without sufficient funding or responsible management will fail; that’s axiomatic. It doesn’t necessarily follow that the underlying concept is wrong. After all, the idea of a single-payer health care system — the holy grail of the left — is an amalgam of both Medicaid and high-risk pools. The government will tax everyone, and use that money to decide how to pay providers for treatment. And if you are high-risk, it still covers you using those tax dollars.

But just because that is a way to try to structure a health care financing system, it doesn’t mean it is the only way. And that is the beauty of our American system and the AHCA; it returns those decisions, coupled with flexibility, to the states.

The 2011 reforms to Maine’s health insurance market, now called P.L. 90, provided many of the same protections as ObamaCare. (Yes, a Republican-led law shared similar goals with the Democratic president — it is almost as if we all want positive outcomes, but disagree on how to achieve them.)

For example, you could not be denied coverage for a pre-existing condition. But if your insurance company thought you might be “high-risk,” they would essentially buy their own insurance policy on you through Maine’s “high-risk pool.” That re-insurance was expensive for the insurance company, so it required them to think long and hard about balancing your risk against your premiums. You had a choice of insurance provider, and your choice then had to make a business decision — this was a market-driven approach.

If the core tenets of the AHCA pass, other states can do different things with the block grants and flexibility provided by Washington. Vermont effectively established a single-payer system back in 2011, but abolished it in 2014. Why? In part, they were $2 billion short in funding for the adventure, so it failed. But they were also hamstrung by strings attached to federal dollars.

With newfound freedom over the federal cut of health care spending, who knows? Maybe the Green Mountain State could find a way to make a single, government-run program work in America and prove naysayers wrong. Or maybe the Maine model could reflect our state motto, leading other states to workable solutions. Or some other state could copy the Swiss approach, compelling everyone to buy private insurance but preventing insurers from making a profit on basic, government-regulated plans.

There are seemingly countless ways to structure insurance markets to maximize coverage and minimize cost. And, similar, but different, from that conversation, we need to find ways to reduce actual, direct costs for health care, not simply the insurance premium.

But, with apologies to the current president and his predecessor, this stuff is very complex, and even if you like your plan, it might end up changing.

Yet despite all that, we can be sure of one thing: Generalissimo Francisco Franco is still dead.

Michael Cianchette

About Michael Cianchette

Michael Cianchette was the chief counsel to Gov. Paul LePage from 2012-2013 and deputy counsel from 2011-2012. A Navy reservist, he was deployed to Afghanistan from 2013-2014 as a trainer and adviser to the Afghan National Police. He is an alumnus of the Leadership Maine program and holds a BA in economics and political science from Boston College along with a JD and an MBA from Suffolk University. He works as in-house counsel and financial manager for a number of affiliated companies in southern Maine.