Once again, proof that the central issue in the Affordable Care Act for insurers is the pre-existing conditions emerges in the form of a bill that Maine Republicans worked hard to steamroll through the legislature, hoping the element of surprise would cover up what they are doing, not to mention breaking their own rules about reading the bill before voting.

What makes this effort so incredibly evil? Maine Republicans substituted a 29-page amendment to their original 4-page bill just before bringing it to the floor for a vote.

A week after the supposed public hearing on LD 1333, the amended version — a 29-page replacement of the original four-page bill — was still not available online to the public Wednesday afternoon. It is made available here by the BDN, although the bill was amended again late Wednesday and that version is not available to the public.

Ultimately, it was that substitution that has slowed down passage of the bill. Democrats objected to the second reading of the bill, arguing that it had not been posted or made available to the public. The original 4-page version expanded existing rate bands for age and smoking from 1.5x the base to 3x the base rate. That was all it did.

The amendment, which I just downloaded from the Maine legislative site, is actually 42 pages long. It does substantially more. Here are some highlights, gleaned on my first pass through it:

• Expands rate bands for age and geographical location from 1.5 times base to 5 times base in 2015. This rate spread is 2 times greater than the maximum under the Affordable Care Act. Rating for geographical location is not permitted at all under the ACA.
• Permits out-of-state insurers from Connecticut, Massachusetts, New Hampshire and Rhode Island to sell insurance in Maine.
• Creates a mechanism to track and keep names of those with pre-existing conditions in a database by forcing insurers to obtain a "health statement" in order to participate in a state reinsurance pool.
• Forces those with pre-existing conditions into high-risk pools, separating them from the healthy insured population. Those pools will be reinsured by the state paid for via an assessment on insurers of $4 per month per insured, which of course will be passed through to insureds.
• Allows insurers to file rate increases without prior approval, provided they claim a Medical Loss Ratio equal to 80% of premiums paid.

There is more. Much more, but it's quite complicated and relies on existing law which I haven't reviewed. Yet, Maine GOP legislators expected the Assembly to vote on this today, almost as soon as it was published.

Portland Press-Herald:

L.D. 1333 allows out-of state insurance companies to sell plans here with fewer benefits. It allows higher premiums for older people and requires the sick to get coverage in separate plans.

Proponents say getting the sick out will lower premiums for all, but offer no data. To support this scheme, L.D. 1333 disrupts the market and raises taxes on every man, woman and child who has health insurance.

In his remarks today on the Assembly floor, Rep. Treat read some sobering statistics about how premiums would rise for those age 48 and older in Maine.

• 4.9% of the Individual Market will see an average rate increase of 29.9%
• 42% will receive premium increases of some amount; the average age of the policyholders who will see rate hikes is age 48
• Maine people living in the North will experience on average a 19% rate increase
• Maine people living in Down East will experience a 22% rate increase
• Maine people who want to keep the insurance policy they currently have will see price increases rise as high as 170 percent over the next 3 years

And these increases don’t even account for the $48 dollar per head annual tax ($292 for a family of four) on anyone who buys health insurance.

It is so interesting to watch these health insurance debates play out in the states. We will see polar opposites play out in New England if this passes. This bill contains all of the 'reforms' proposed by House and Senate Republicans during the national health care debate -- selling across state lines, carving out those with pre-existing conditions and placing them into high-risk pools, and wide premium differentials across age and geographical locations. In Vermont, a simple single-payer plan was chosen. In California, single payer is winding its way through the system once again, after passing the Assembly and Senate twice before, only to be met with a veto.

I assume Maine's legislation will indeed become law at some point, and that we will have an opportunity to see the differences between Maine's insurance structure and Vermont's in action. That is, unless everyone over the age of 48 and under age 65 in Maine decides to move to Vermont.