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As the GOP health care bill moves from the U.S. House of Representatives to the Senate, many consumers and lawmakers are especially worried that people with preexisting conditions won鈥檛 be able to find affordable health coverage.

There are a number of strategies under consideration, but one option touted by House Republicans borrows an idea that Maine used just before the Affordable Care Act went into effect. It鈥檚 called an 鈥渋nvisible high-risk pool鈥� 鈥� invisible because people in it didn鈥檛 even know they were.

The Maine pool earned higher marks than most state high-risk pools because it had a key ingredient: enough money.

鈥淭he problem is that in order to do the Maine model 鈥� which I鈥檝e heard many House people say that is what they鈥檙e aiming for 鈥� it would take $15 billion in the first year, and that is not in the House bill,鈥澛�. 鈥淭here is actually $3 billion specifically designated for high-risk pools in the first year.鈥�

Here鈥檚 how the Maine model worked: When a resident applied for health insurance, they had to fill out a questionnaire. If they had certain medical conditions known to be costly, their application was flagged for the high-risk pool. To consumers, it was seamless: They paid regular premiums and got the same sort of coverage as any other enrollee in their chosen health plan.

What was different was how their medical bills were paid. The state set up a nonprofit entity 鈥� the Maine Guaranteed Access Reinsurance Association, or MGARA. Mitchell Stein, an independent health policy consultant, explained that the money to pay for these high-cost patients came from two sources: the insurance policy premiums paid by patients within that high-risk pool and a $4-a-month surcharge on all policyholders in the state.

This 鈥渋nvisible high-risk pool鈥� was just one part of a larger health reform law in Maine, Stein said, and that makes a straight-up assessment of how well the strategy worked difficult. But it鈥檚 鈥渁 great theory,鈥� he said, 鈥渁nd can be an appropriate way to handle these things.鈥�

Eric Cioppa, superintendent of Maine鈥檚 Bureau of Insurance, agrees with Stein. 鈥淚n Maine, for the period of time it was operating, it worked very well,鈥� Cioppa said.

It was active from 2012 through 2013, as 2014 marked the聽advent of the Affordable Care Act鈥檚 marketplace insurance exchanges. Though in effect only for a brief period, Cioppa said, the invisible high-risk pool did keep costs down in the individual market, where Anthem was the largest insurer.

Without the invisible high-risk pool, Cioppa said, Anthem would have increased rates more than 20 percent, based on estimates the insurer had to make. Instead, the rates went up less than 2 percent.

叠耻迟听, policy director of the Maine-based advocacy group Consumers for Affordable Health Care, cautioned that one crucial component that made Maine鈥檚 high-risk pool work was that it was well-funded. The strategy proposed in the House Republicans鈥� American Health Care Act is not, he said.

鈥淎n analysis that was done on what this program would need showed that it would need $15 billion to $20 billion per year to have any kind of reasonable impact on premiums,鈥� Butterfield said.

The GOP bill does allocate about $15 billion to $20 billion 鈥� but that is supposed to last聽almost a full decade, not per year.

鈥淥ne of our concerns,鈥� Butterfield said, 鈥渋s if the feds are going to put this in place and only kick in a token amount of money, is it going to be up to the states to pick up the slack and pay into this thing to make it work?鈥�

Furthermore, Butterfield said, as the law stands now, under the Affordable Care Act, there鈥檚 no need for high-risk pools of any sort. The idea to use invisible high-risk pools is a solution to a problem that the GOP health care bill creates. Right now people can buy insurance regardless of their health status, whether or not they have a preexisting condition. It鈥檚 the GOP bill that would allow states to opt out of that Obamacare rule.

鈥淚 don鈥檛 understand,鈥� Butterfield said, 鈥渨hy it would be a good idea to, on the one hand, say, 鈥榃ell, we鈥檙e worried about preexisting conditions, so we鈥檙e going to throw not enough money at a problem we鈥檙e creating. At the same time, we鈥檙e going to allow insurance companies to charge sick people more.鈥� 鈥�

And the invisible high-risk pool, said consultant Stein, is just one small proposal within the larger health bill.

鈥淭here鈥檚 nothing inherently wrong with it,鈥� Stein said, 鈥渂ut it doesn鈥檛 really fix all the other problems of the bill.鈥�

Which, he said, include cuts to Medicaid and potential changes to what are, under Obamacare, guaranteed 鈥�.鈥�

This story is part of a partnership that includes , and Kaiser Health News.