Maine
State of Maine Plan |
Plan StatusIn effect, but in flux. Enrollment has been suspended because of a lack of funds, and federal contributions may no longer be available.
Plan Sponsor(s)The Dirigo Health Reform Act was proposed by Governor John Baldacci (D) and signed into law on June 18, 2003.Number of People CoveredGoal is for all residents of Maine to have health insurance by 2009.Estimated Cost$53 million to launch the programPayment Scheme Includes private, employer-based, and government-funded health insurance. Relies largely on Medicaid funding.
Insurance company savings resulting from the projected decrease in uncompensated care to be collected by the state as an “assessment.”
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Plan in Briefs
- Is state-run and relies on state funds as well as employer and employee contributions, insurer savings, and Medicaid funding.
- DirigoChoice, extends insurance to more poor people by offering discounts to individuals, small businesses and the self-employed.
- Requires hospitals to present a Certificate of Need when buying expensive new equipment or services.
- Savings achieved are returned to the plan.
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Impact on Federal Government
- With this program, Maine expands Medicaid and thus gains further federal funding. Funding is now being denied, a decision Maine is appealing.
Impact on States
- DirigoChoice is state-run and uses state funds.
- MaineCare, the state’s Medicaid program, was expanded to cover more children and more childless adults.
Impact on Insurers
- “Savings offset assessment” asks insurers to pay back to the state the savings they make following a reduction in uncompensated care and other savings based on the efficiency of Dirigo Health. Insurers remain opposed to this policy.
Impact on Providers
- DirigoHealth establishes the Maine Quality Forum, whose goals include monitoring and reporting on the quality of healthcare and furthering best practices and evidence-based approaches.
Impact on Employers
- Must pay 60% of premiums for employee-only coverage
Impact on Individuals
- More children and more childless adults are eligible for MaineCare, the state’s Medicaid program.
- Small businesses, the self-employed, and individuals can purchase health insurance on a sliding scale.
- DirigoChoice and MaineCare have no pre-existing condition exclusions.
| Proponents/Opponents |
Proponents argue that voluntary, long-term reform of Maine’s healthcare plan, with possible sanctions later, will lead to comprehensive sustainable improvement.
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Critics say that the savings to date are unimpressive, that employers have little incentive to enroll employees who are eligible for MaineCare, and that the reliance on federal funding was always questionable. They also charge that asking the insurance companies to pay back, to the state, the money they save from a reduction in uncompensated care will cause the insurance companies to increase premiums, which is essentially a "back door tax" on those who are paying for their own insurance. Hospitals were opposed to restraints on their purchasing.
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Notable Features
- Enrollment is currently frozen, and federal funds are no longer available; funds paid previously may need to be reimbursed. Maine is appealing the federal decision.
- The “savings offset assessment” creates a funding option by requiring insurers to contribute funds once the program has demonstrated savings. The requirement, insurance companies’ means of providing that funding, and the level of savings to date are all controversial.
- The program opens access to small businesses and the self employed by providing discounts akin to group health insurance.
- Beginning January 1, 2008, Harvard Pilgrim Healthcare of Massachusetts has taken over as the insurer for DirigoChoice; original provider Anthem Blue Cross and Blue Shield of Maine and DirigoHealth were not able to reach an agreement for ongoing coverage.
Experts' Comments" The state's ability to subsidize premiums is limited by the financial ability to raise additional funds.…They're basically in a capped mode now for people who qualify for the premium. Until they resolve that issue, it's unlikely they'll expand coverage."
-- Mark Ishkanian,
Anthem Blue Cross and Blue Shield, to the AIS Report
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For further reading and listening
Dirigo Health Reform
An Interview with the Director of the Governor’s Office of Health Policy and Finance
Maine Health Care Reform Debate
The Kaiser Commission’s Report on MaineCare
Anthem BCBS and Maine's Dirigo Go Separate Ways in 2008
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