Dirigo Health took away some insurance company power to empower patients

No Maine tax payer funds ever funded Dirigo

BY RAMONA DU HOUX

February 28th, 2011 

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“Dirigo Choice, the health insurance arm of the health-care act, has an enrollment of about 15,000 with 583 small companies,” said Gov. Baldacci. photo by Ramona du Houx

Despite the fact that Dirigo Health has saved lives, Gov. LePage’s proposed budget gets rid of the program. The administration claims that Dirigo is too expensive for the taxpayers of Maine. But the truth is: No General Fund money has ever been spent on the program.

“There is no General Fund money spent on Dirigo,” said former director of Gov. Baldacci’s Office of Health Policy and Finance. “In fact, it covers 6,700 parents on MaineCare whose children are covered. So, you would either cut 6,700 people off MaineCare, who are paid for by Medicaid, or the General Fund would have to come up with over $6 million, if you eliminate Dirigo.”

To be clear: Maine taxpayers, who have never had to pay two cents for Dirigo, will have to come up with $6 million to cover of 6,700 people who need the program, if Dirigo is dismantled.

Successes of the Dirigo Health Care Act of 2003:

• In 2003, Maine ranked 16th healthiest among the states; today Maine is 8th. In 2003, Maine ranked 19th among the states in covering the uninsured; today Maine is 6th.

• Over the past seven years Maine has created an efficient public health system with eight districts that cover the entire state through Healthy Maine Partnerships.

• Maine created ways that enabled its citizens to become healthier – using tobacco settlement funds.

• Dirigo’s insurance carrier cannot deny insurance coverage on the grounds of a patient having a preexisting condition. For preventative care and primary care there are no copayments involved. These provisions have saved lives.

• Dirigo has helped more than 34,000 Mainers get health insurance since it began. Dirigo Choice, the health insurance arm of the health-care act, has an enrollment of about 15,000.

• 583 small companies in Maine offer health-care coverage through Dirigo Choice.

“When we set the program up, we did it with one-time federal funding that was being made available to the state. We focused on making it pay for itself. We figured that if we started to decrease hospitalization and emergency room visits and reorganize administrative systems, then a percentage of those monetary savings could be fed back into covering people, making it self-sustainable,” said Gov. John Baldacci. “We recycled those revenues back into the fund to keep it going.”

These savings-offset payments worked for four years, but there was always a constant battle, because insurance companies wanted to keep the savings for themselves. The bottom line was: The insurance companies didn’t want to use for people’s healthcare the savings that Dirigo helped them make.

In 2009 Dirigo’s funding stream was stabilized with a 2.14 percent assessment on claims paid by insurance companies. The rest of the funding for Dirigo comes from member and employer payments, the federal government, and tobacco lawsuit settlement dollars. The assessment paid by insurance companies would be eliminated when health insurance exchanges are created with the Affordable Care Act (ACA) implementation.

Because Dirigo refused to use Maine taxpayer revenue, it was constrained in how big it became.

“We worked within the money we had, not to put any tax burden on individuals,” said Baldacci.

Since Congress enacted ACA, Dirigo has been providing the framework for implementing the new legislation.

“In Maine we are poised to be a frontrunner when it comes to implementation of the ACA. Our efforts with prevention and wellness funded through Healthy Maine Partnerships have improved the health of our people,” said House Minority Leader Rep. Emily Cain. “Because of the Dirigo Health Care Reform Act, while other states have just started insurance regulation, discussions were already there. And other states are trying to change to a culture of prevention and wellness — we’re there.”

Maine’s population has become healthier due to Dirigo Health reforms.

“Maine can legitimately boast of ranking sixth for the best in health insurance coverage in the country, and being the eighth healthiest state in the country. One of the benchmarks I looked at was prevention. If we could improve the overall health of the people of Maine, then we could have an impact in terms of long-term health-care costs, and the quality of health of individuals,” said Baldacci. “We created Quality Forums, so physicians and consumers could weigh in on health care, and best practices could be established. Now, Maine is nationally recognized for our health data network. Because this data is accessible to citizens, they can shop and compare. And health-care providers can see what everyone else is doing in their field, so they can improve their practices and health-care outcomes. We now have a much more transparent system.”

White House Office of Health Reform Director Nancy-Ann DeParle came to the University of Southern Maine in Portland last fall to praise Maine’s efforts in implementing the first stages of ACA.

“Maine has been very progressive in trying to make sure that consumers — and not insurance companies — control their health care,” said DeParle at that time. “I think the work that Maine had already done with Dirigo enabled it to make sure people in Maine got the assistance fast. And that work will help with further implementation of the law.”

Riley said, “Every Mainer stands to benefit from the federal law. As many as 500,000 Mainers could be eligible for subsidies to help pay for health insurance, and more private competition will be created.”

Last December the state issued a plan, Options and Opportunities for Implementing the Affordable Care Act (ACA) in Maine, to help the state transition to the ACA. The plan is a result of the work undertaken by Governor Baldacci’s Steering Committee and Advisory Council set up to ease the ACA transition since national health reform was enacted.

“I was a part of the hearings that had a unanimous, bipartisan consensus to move forward implementing the many aspects of the Affordable Care Act, particularly the insurance exchange of 2014,” said Cain. “Insurance companies say they don’t want a lawsuit, ‘because the individual mandate makes it work for us.’ It’s about making sure people have access to health insurance.”

But Gov. LePage has chosen to join the national Tea Party effort in a lawsuit to stop the ACA from being implemented.

“There is a slippery slope, if we start to criminalize the implementation of federal law. Every teacher, police person, military person could be penalized, if you try and set a precedent that criminalizes a federal law,” said Cain. “We need to focus our efforts on how we can maximize and speed up the implementation, rather than playing political stunts.”

UPDATE: Dirigo enrollment on the rise despite Gov. LePage’s attempt to dismantle the program