AUGUSTA, Maine — U.S. Rep. Bruce Poliquin voted on Thursday to back fellow Republicans’ plan to replace the Affordable Care Act, breaking his silence on the American Health Care Act just before the vote in the House of Representatives.

The impact that it would have on Poliquin’s 2nd District, which is older and more rural than the rest of Maine, is unclear. Estimates for an earlier version of the Republican plan showed it would decrease subsidies for older, low-income Mainers in rural counties.

[MORE: The part of Maine that backed Trump is least likely to benefit from GOP health plan]

Republicans pulled that plan for lack of support from conservatives in March, but a revised version passed in a 217-213 vote on Thursday after the addition of a provision based on Maine’s 2011 health care reform law that established high-risk pools to subsidize premiums for people with pre-existing conditions.

The amended bill hasn’t been evaluated yet by the Congressional Budget Office, but the office’s earlier estimate said 24 million would lose insurance by 2026. Average premiums would decrease starting in 2020, but insurers would be able to charge more for older people.

While the bill is written in a way that looks to maintain protections for people with pre-existing conditions, health policy experts have said it would allow insurers to raise rates to a degree that would make insurance unaffordable for those people.

On a Thursday conference call, Poliquin told reporters that the bill “ensures that everybody has access to health insurance, including those with pre-existing conditions.”

In Maine, 77,000 people planned to get insurance via the Affordable Care Act earlier this year. But Poliquin has long pointed to problems in that market. One of Maine’s three participating insurers, Anthem, may leave markets without changes. Another, Community Health Options, lost $58 million in 2016.

But Poliquin is the only member of Maine’s congressional delegation to support for the plan. U.S. Rep. Chellie Pingree, a Democrat from Maine’s 1st District, voted against it on Tuesday, saying it’s “reckless” and “will harm millions of Americans” in a statement.

Now, the bill is certain to face large changes in the Republican-led but more moderate Senate, where U.S. Sen. Susan Collins, a moderate Republican who has reservations about the House plan, could be a key swing vote.

She said in a Thursday statement that there are “more questions than answers” on it and is “particularly concerned” about its effect on low-income, rural people. U.S. Sen. Angus King, an independent who caucuses with Democrats, opposes it. He said in a Facebook video on Thursday it is a “shift and shaft” plan that is will “cost Maine people their health insurance.”

Gov. Paul LePage, who was in Washington, D.C. earlier this week, supported the original Republican plan, but he spoke against allowing pre-existing conditions to “set rates” Tuesday on Fox News. A spokesman for the Republican governor said he wouldn’t comment on the vote.

Michael Shepherd

Michael Shepherd joined the Bangor Daily News in 2015 after three years as a reporter at the Kennebec Journal. A Hallowell native who now lives in Augusta, he graduated from the University of Maine in...