Maine's Healthcare - Dirigo Choice - enrollment increases

By Ramona du Houx - March 27th, 2011 · 

On March 23 the administrators of Gov. Baldacci’s Dirigo Health program testified in Augusta that the number of private businesses signing up for insurance has increased significantly since last fall. The demand for health care coverage, which accepts pre-existing conditions as well as yearly check ups – is still high.

“In light of all of the news out there about the future of this program, we still have seen significant interest from employers throughout the state as well as from individuals and sole proprietors,” said Karynlee Harrington, executive director of the Dirigo Health Agency.

The Dirigo program will continue to provide insurance coverage through 2013.

Since the program began accepting new businesses and individuals, last fall, with the help of funds from the Affordable Health Care Act enrollment has increased. Over 140 small businesses and 2,000 new individuals signed up.

DirigoChoice, the insurance arm of Dirigo Health offers subsidized health coverage to eligible individuals as well as insurance plans to small businesses.

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.

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 Choice, the health insurance arm of the health-care act, has an enrollment of about 16,000.

• 623 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 in a previous interview. “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, in three years.

The LePage administration proposes to dismantle Dirigo by phasing out the assessments paid for by insurance companies in his current budget as well as the Fund for A Healthy Maine.

Harrington said that, beginning in 2014, Dirigo could be transformed into the state health exchange with the ACA. Current Dirigo participants could then obtain health coverage through the exchanges.

Continuing to fund Dirigo fully until the ACA health exchanges take over would insure a smooth transition for those using Dirigo Choice insurance.

“It’s a logical next step,” said Harrington.

Dirigo’s Board of Trustees is scheduled to meet on April 4 to discuss how to proceed if the programs face reduced funding.

Just about a year ago Governor John Baldacci was honored in Washington D.C., with the American Medical Association’s top government service award for an elected official.

“Governor Baldacci has truly improved the health of the people of Maine with the creation of Dirigo Health Agency,” said AMA Board Chair Rebecca Patchin, M.D. “He has also led the effort to improve and enhance Maine’s public health infrastructure, and a universal wellness initiative.”

Despite the negative rhetoric fueled by the Heritage Policy Center about Dirigo Health the program has been a success. And it continues to save lives.

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 Gov. Baldacci’s Steering Committee and Advisory Council set up to ease the ACA transition since national health reform was enacted.

Trish Riley, former direction of the Dirigo agency previously stated, “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.”

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