“We were shocked,” said Monique Kenyon when she found out her husband was suffering from cancer. “Being a middle-income family we didn’t qualify for any assistance. We couldn’t afford all the treatment without insurance, but insurance companies wouldn’t accept him because he has this preexisting condition. He’s still with us because of Dirigo.”
There aren’t any official numbers for how many lives have been saved because of the Dirigo Health Reform Act of 2003. If only one, then the program has proven its effectiveness. Currently about 11,000 people who couldn’t afford insurance on their own are covered by DirigoChoice, the health insurance arm of the health-care act. But due to funding constraints, enrollment had to be capped.
The Affordable Care Act, which was signed by President Obama six months ago, enabled DirigoChoice, offered by Harvard Pilgrim Insurance, to accept new subscribers.
Edward Kenyon of Kenyon Electric was the first to enroll.
“Edward, has Multiple Myeloma,” continued Monique Kenyon. “Now that we have Dirigo he has finally been getting chemotherapy and will receive a bone marrow transplant soon.”
“Maine has been very progressive in trying to make sure that consumers — and not insurance companies — control their health care,” said DeParle. “I think the work that Maine had already done with Dirigo enabled it to be up and running really quickly and make sure people in Maine got the assistance fast.”
Under the Dirigo Health Reform Act, DirigoChoice cannot deny insurance coverage on the grounds of a patient having a preexisting condition. On July 1, the federal Pre-Existing Condition Insurance Plan started to provide coverage for eligible Americans who have been uninsured for six months because of a pre-existing condition. The program is up and running in Maine already, using DirigoChoice.
“All Americans should have access to high-quality, affordable health care. We cannot have a healthy economy without healthy people,” said Governor Baldacci. “The federal health reform law provides new opportunities for Maine to cover more uninsured and address the cost and quality of health care. The folks you see here today are hardworking Mainers, who have before this law been unable to gain access to affordable coverage. This is a matter of life or death. It’s their stories people need to know about.”
Bob Belisle, a property manager from York, said, “I recently had to go in for unexpected stomach surgery. I went in for a normal checkup, and they kept me in the hospital because my stomach was septic. I wouldn’t’ be standing here today without Dirigo. It saved my life.”
Maine also extended coverage, before the federal law did, for young adults who wanted to stay on their parents’ health-care plan.
DeParle also recognized Maine for using federal grant money in the fall of 2009, from the Health Resources and Services Administration, to start a voucher program. The voucher program provides financial assistance to help uninsured, part-time and seasonal, lower-income workers pay for health coverage offered by their employers for themselves and their families.
“For as long as I’ve been in business, I’ve been searching for a program that would help us cover our part-time employees,” said Jim Talbott, director of Merrymeeting Behavioral Health Associates. “It wasn’t possible until now. It’s a great recruitment and retention opportunity, as well as an incentive for workers to become full-time employees.”
DeParle also commended the State for giving the Maine insurance superintendent the ability to enforce the federal law.
“Some states are not yet prepared to enforce them. But Maine is. Maine’s Legislature passed the changes that it needed to be able to enforce the law,” said DeParle. “Maine shows the strength of what a state can do on its own, and some of the limitations. Financing on a national level has made it possible for Dirigo to remain healthy.”
In 2003, Maine ranked 16th healthiest among the states; today Maine is in the top ten. In 2003, Maine ranked 19th among the states in covering the uninsured; today Maine is sixth. 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.
Dirigo Health administrators expect membership in Dirigo’s programs to double to about 16,000 within a year, with people coming in through the Pre-Existing Conditions Plan and the voucher program. The program does not use any tax revenue dollars.
“We’ve been a model for the nation. Now we are the bridge,” said Trish Riley, director of The Governor’s Office of Health Policy and Finance. “We’ve been fighting the fight to save lives by offering affordable, quality, health care and preventative care. Now the federal government is taking it on, which is great news for Maine and the nation.”
Some have said the national plan will balloon the deficit. But the nonpartisan Congressional Budget Office figures tell a different story.
“The Congressional Budget Office says that over two decades it will actually reduce the deficit by over a trillion dollars,” said DeParle. “It slows the rate of Medicare growth, and there are incentives for high-cost plans to bring their costs down.”
Other provisions of the national reform already have taken effect, including small-business tax credits for employers that offer insurance to their workers and $250 rebates to senior citizens who fall into the Medicare Part D gap in prescription drug coverage.
For more information about Dirigo health coverage, visit www.dirigohealth.maine.gov.
For more information on Maine’s work to advance the federal health care reform law, visit www.maine.gov/healthreform.
The Affordable Care Act also helped Maine with prescriptions in 2011 by:
Nearly 12,000 Maine residents who receive Medicare saved $6.3 million on their prescription drugs in 2011 due to the Affordable Care Act law.
The Department of Health and Human Services said savings for people with Medicare would increase over time to nearly $4,200 by 2021 because of the Affordable Care Act.
The law provides a 50 percent discount on brand-name prescription drugs, and this year a 14 percent discount on generics. Last year, it provided a 7 percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the doughnut hole.