Building a foundation in Maine for universal coverage

New healthcare laws heralded, Dirigo Choice stabilized

By Ramona du Houx

July 3rd, 2009 

Trish Riley, the Director of the State's Health Office, is the architect behind Dirigo Health
Trish Riley, the Director of the State's Health Office, is the architect behind Dirigo Health
Maine’s lawmakers have been leaders in healthcare reform for successive legislatures. Maine’s prescription drug plan is recognized nationally. In 2003 Dirigo Health Reform was established. Its programs can be credited for be decreasing the number of people who were uninsured and underinsured during a time when those numbers increased across the nation. For five years the rate of uninsured has dropped in Maine.

Key initiatives that address cost, quality, and access to health care have passed this session. They were celebrated at a Statehouse ceremony.

“This Legislature has shown its commitment to improving health care for all Maine people,” said Governor Baldacci. “Taken together, these bills will help advance the broad goals of the original Dirigo reforms to make quality, affordable health care available to all Mainers and to work to make Maine the healthiest state in the nation.”

Governor’s bills on public health, medical error reduction and healthcare insurance, including DirigoChoice, were among the many celebrated. Other recently signed legislation to reduce infections in hospital settings, establish medical school scholarships, enhance telemedicine services, and to improve healthcare transparency were also highlighted.

The most controversial to pass was the funding mechanism for DirgoChoice, the health insurance arm of Dirigo Health.

While healthcare costs skyrocketed nationwide as premiums increased, Maine valiantly pushed to cover people who fell between the cracks, not making quite enough to cover themselves, their families, or businesses.

For some people covered by DirigoChoice, lives were saved, because the healthcare paid for preventative measures. The opposition, led by Maine’s Heritage Policy Institute and lobbyists hired to ensure the status quo, attacked Dirigo’s potential from the start.

The reality that lives were saved, that businesses insured more workers, and that the people enrolled in DirgoChoice could feel secure having health care happened to more than 29,000 people.

Last year Paul Hollingsworth, co-owner of Henry and Marty’s Restaurant, said, “Two of our employees signed up after never having health insurance in their lives. Dirigo is very important to them.”

Then the program faced an out-of-state advertising spending spree that proclaimed the nickel or dime on wine or beer really was a tax that people couldn’t afford. As a result of the advertising blitz against the healthcare program, voters withdrew the mechanism that would have covered the program’s costs.

Close to 10,000, people who are enrolled in the program are breathing a collective sigh of relief because An Act to Stabilize Funding and Enable DirigoChoice to Reach More Uninsured is now law.

The legislation directs Dirigo’s board of trustees to revamp the program to make it
more affordable. The law also replaces the savings offset payment with a monthly payment from insurance companies that equals 2.14 percent of their total claim payments. It’s estimated that would generate $42 million a year.

Gov. Baldacci signs healthcare legislation this spring
Gov. Baldacci signs healthcare legislation this spring

Having a monthly payment makes the funding stable. According to officials it took two years for funding to work through the bureaucratic savings offset payment system. The new system would reduce administrative costs associated with rate-setting proceedings.

Rep. Sharon Treat, sponsor of the law, said the program “may well prove to be a bridge program as we move to a more comprehensive state or federal healthcare system. For now it remains an important option for many Mainers.”

In addition to offering health insurance, the program covers some state Medicaid recipients and convenes boards responsible for working to contain costs. Because of the funding issues relating to the savings offset payment, the state had capped enrollment in September 2007. There is still a great demand for the program, with a waiting list of 2,000 people.

“We want hard-working families and businesses to prosper and thrive, and that simply is not possible without having access to health care that is affordable and of high quality,” said the governor. “We are complementing what they are doing in Washington, DC. Maine can’t do it all by itself. We are trying to create a foundation where our people have more information, one that involves them in the decision-making process, building it from the ground up. So that when a national solution steps forward, it will be able to fit into what we are doing and provide universal coverage. We’ve sustained DirigoChoice, so that people have a choice.”

New laws to help Mainers become healthy —

“This year we passed the Universal Wellness initiative, which provides community-based support and services to help people be healthy,” said the Governor.

This bill coordinates and streamlines the public health system in Maine. The law prepares the state’s public health system for federally recognized public health accreditation and ensures the effective, efficient and evidence-based delivery of essential public health services. The bill recognizes and formally establishes Healthy Maine Partnerships, which will serve as district coordinating councils for public health and the Statewide Coordinating Council for Public Health. The universal wellness initiative will use the existing resources of the public health infrastructure.

Almost two-thirds of Mainers are either overweight or clinically obese. The problem has become worse recently. Obesity rates more than doubled from 12 percent of residents in 1990 to 26 percent in 2006. What’s even more terrifying is nearly a quarter of Maine children are obese, according to a 2008 report by the Robert Wood Johnson Foundation. That statistic is on the rise, with estimates stating it’s now close to 30 percent.

“This is a critical public health issue, especially when it comes to our children’s health. It’s estimated that 30 percent of our youth are overweight or obese,” said Governor Baldacci.

Some major laws took steps to help curb the obesity problem.

House Whip Seth Berry sponsored a measure that creates an Obesity and Chronic Disease Fund to pay for training or staff to increase physical education in elementary schools. The fund can receive donations from public or private sources.

“A lot of people assume that gym class is a central part of every kid’s school day,” said Rep. Berry. “We need to reassert physical activity in schools to present a better balance and improve the health of Maine kids.”

Rep. Helen Rankin, spent nearly 50 years working in school kitchens or as a director of food service for schools. Rankin’s bill will require schools to take the height and weight measurements of children and report that data to the Maine Center for Disease Control. The information would remain confidential.

House Speaker Hannah Pingree’s law requires chain restaurants to post calorie information on their menus and menu boards.

Polls conducted in New York City after a similar measure was put in place showed 80 percent of respondents said they changed their behavior based on calorie information provided. The governor hopes other restaurants will take the initiative on their own to post calorie information on menus and boards.

“When you look at the calorie data, prepare to be surprised,” said Speaker Pingree. “The point of this policy isn’t to tell people what not to eat, but to give them information. The healthy choices at many chain restaurants may not be what you think they are, but by putting calorie information on the menu, we can help people make better choices.”