“Dirigo Choice makes healthcare affordable for small business owners,” said Robin Mills co-owner of Bethel’s Best Pizza. “We felt a need to take care of our employees — with Dirigo we are.” Photo by Ramona du Houx

Winter 2005- 2006

Article by Ramona du Houx

“Every one of us – every man, woman and child in Maine – needs and deserves affordable, quality health care that we can depend upon. That’s why on my first day in office I started the hard work to create the Dirigo Health Reform. I said then that the road was long, the work was hard, but that it was work that had to be done,” stated Governor Baldacci on March 15 when he announced Dirigo’s next step: to self-insure.

Nationally 82 percent of firms with 5,000 or more workers have plans that were partially or fully self-insured.

“We want the option to self-insure because it allows us to move more quickly to develop new, innovative and more affordable benefits; to cover more people by expanding Dirigo’s reach beyond the small group of brokers who market it today,” stated the governor.

In order to authorize Dirigo’s board to self-insure, instead of contracting with a private company to provide coverage to the thousands of Mainers, the measure has to be voted on by the Legislature.

If the state goes with a self-insured system, the middleman is removed from the picture. Taking away the middleman creates savings which can be used to pay for more coverage.

“If the Legislature enacts this proposal, we will have the necessary options available to guarantee the best product at the best price and effectively reach even more people,” said Governor Baldacci. “My message today to every Maine citizen, to every business, is that we are serious and committed about health reform. I will work with all the stakeholders to ensure that we meet our goals, because this is the right thing to do.”

This new measure could insure Dirigo’s future and over 15,000 people who now are covered would breathe a sigh of relief.

“It’s peoples’ stories that make the importance of Dirigo real,” said Peter Robbins who stressed the need for Dirigo to continue last February. Robbins cofounded Steppingstones Home Builders with Jim Dinnan and invited the governor to visit his business in Blue Hill to talk about health care. Fifteen years ago Robbins, a graduate of Brown University, came to Maine for the quality of life, to start a business, and to raise his family.

“We had always hoped to be able to provide heath insurance for our employees. When Dirigo came along we found that we could. We had carried health insurance for ourselves, but had not had a lot of luck getting the crew to fit into a health insurance plan we felt was affordable for the company and that they could afford to pay for,” Robbins said. “With Dirigo, it was easy.”

Health-care costs are forcing companies to relocate to Canada. Insurance costs have skyrocketed with their own “tax increases” on consumers. Too many people can only afford catastrophic coverage which has deductibles that are in the tens of thousands of dollars — which amounts to a legalized protection racket.

Baldacci took on the most important internal national issue facing all Americans with Dirigo Health. Maine is being viewed as a national leader in its attempt with Dirigo to cure the health-care crisis. Baldacci has been asked to speak at various forums, and most recently at the American Medical Association meeting, about the program. National publications and TV stations are reporting on Dirigo.

“A lot of people are watching Maine,” commented the governor. “People are approaching us. They are interested in how we are handling this national crisis.”

•     Dirigo supports programs that are geared to making Maine the “Healthiest State.” By ensuring people have access to care and advice before they become ill, Maine is becoming healthier. Maine recently became the number one state to reduce teenage smoking because of Maine’s preventive measures.

•    Dirigo covers hospital, physician and specialist visits, prescription drugs, and no-cost preventive care. It gives discounts based on household income that lower monthly costs and deductibles.

•     Eighty percent of employees enrolled receive discounts.

•     In addition, Dirigo benefits include: immediate coverage for preexisting conditions, Mental Health Parity, and the Healthy ME Rewards program. Discounts can be as much as 100 percent of the employee’s monthly payment, deductible and out-of-pocket expenses.

•     Dirigo gives business owners a better chance to compete in the marketplace as they save funds — savings that can be put back into their enterprises.

Maine has a strong tradition of finding solutions to health-care problems, which helped to make the creation of Dirigo possible. Maine recently increased its ranking nationally to the eighth healthiest state in the nation, taking 8,000 people off the uninsured rolls. Dirigo played an important roll in achieving this ranking.

How Governor Baldacci created Dirigo is characteristic of his leadership style. He has an inbuilt ability to build coalitions. Working across party political lines, he brought together health insurance providers, health-care professionals, hospitals, the Legislature, and concerned citizens to work on solutions. He knew that there were enough resources within the health-care network to reduce overall health-care costs, while working towards making Maine the healthiest state. He reasoned that if hospitals streamlined their businesses, and if Dirigo could cover charity care and bad debt cases, savings would be made, which has happened.

This collaboration between the state and private sector has yielded savings and has helped keep insurance costs down. Maine’s insurance superintendent ruled that Dirigo has saved insurance providers $43.7 million. “These savings should be funneled back into the program, so that Dirigo could become self-sustaining.”

However, Dirigo’s insurance provider, Anthem, does not want to play its role in this health-care collaborative effort by giving the savings back to Dirigo, despite the fact that they verbally agreed to when Dirigo Health began.

The governor said that Dirigo was always meant to grow and change, as any business would, to make its product better. Becoming self-insured is the next step.

For the first time, many of the 2,000 business with Dirigo can finally afford to insure their workers.

For Steppingstones, Dirigo has had an economic benefit. “It’s been easier to hire new people. We don’t have to worry about the cost of expanding the crew with Dirigo, which makes it easier to take on bigger jobs,” said Judy Robbins, Peter’s wife and Steppingstones’ bookkeeper. “We are up for renewal, and we are able to cover seven people in 2006 for about what it used to cost to cover four people. The premium increase this year is very modest. We’re really pleased with the cost and the fact that we can offer it to more employees.”

One such employee was looking forward to switching from his insurance that has a $15,000 deductible. “It’s highway robbery,” he said.

“I feel great that we have Dirigo. There were some serious health issues we had to deal with; I found the Dirigo people very easy to talk to,” Dinnan said. “My questions were answered, and they were straightforward about what was covered. I’m pleased as could be with the process.”

According to the census bureau there are 130,000 Maine residents that are still uninsured. That’s 10 percent of Maine’s population, which is below the national average of sixteen percent. The governor stated that the goal of Dirigo is to expand access to all the uninsured or underinsured, and he won’t be satisfied until the state reaches Dirigo’s goal.

In this gubernatorial election year many Republicans are claiming this health program isn’t working.

“It’s hypocritical because some of them voted for it but now that the election is around the corner they deny it could be good for Maine. Dirigo has only been selling coverage since January, 2005; it should be given a chance,” said Robbins. “I really commend Governor Baldacci for his determination to continue the program.”

Baldacci said he wants Dirigo to move to a self-insured system as of Jan. 1st, 2007. Anthem’s contract runs out December 31st, 2006.

Changing to a self-insured system could extend Dirigo coverage to more people.

“By avoiding administrative costs and profits, you’re able to stretch those dollars for more people to get affordable health care,” said the governor. “Some propose to separate the wealthy and healthy from the poor and the sick. I will have none of that. We are in this together. It’s not good enough for some of us to be healthy, for some of us to have health insurance. Dirigo Health reform is about all of us — working for the day when no one in Maine worries about paying a premium or paying the heating bill — where every business knows it can provide its workers with good coverage at a fair price, and where all of us work to improve our health and prevent costly illness.”

“Dirigo has to continue,” said Robbins. “Just look at the rest of the nation. The governor is taking the lead. For Steppingstones, I have to say,” Robbins paused, becoming emotional, “having coverage has been literally a lifesaver for some of our people.”