Maine Gov. Baldacci Ready to ‘Re-energize’ Dirigo Health Plan

By | April 5, 2007

Maine Gov. John Baldacci planned a major health policy announcement this week that will focus on insurance market reforms, an expansion of the Dirigo Health program and new regulatory provisions, all designed to promote broader access to health care, according to the governor’s top health adviser.

Trish Riley, director of the Governor’s Office of Health Policy and Finance, said Baldacci would outline a plan to “re-energize” the administration’s ambitious and embattled program to reduce the number of uninsured Mainers, bolster coverage for those with limited financial protections, promote quality and hold down costs.

According to legislative sources who were briefed ahead of the governor’s announcement, elements of his plan are believed to include more flexibility for insurers to shape their products and what were described as employer and individual mandates — methods of setting incentives for providing and obtaining health insurance coverage.

The legislative sources, who spoke in advance of the Baldacci announcement on condition of anonymity, likened parts of the governor’s approach to initiatives brought forth elsewhere.

One lawmaker well versed in health care policy said Baldacci was expected to call for a continuation this year of an especially controversial underpinning of the Dirigo Health program’s financing known as savings offset payments.

The Dirigo Health Agency was established to promote affordable health care coverage, and a key part of the program is its subsidies for low-income individuals and business employees. Subsidies are funded in part from savings offset payments made by health insurance carriers.

Estimated savings have been sharply contested.

In advance of the governor’s announcement, legislative Democrats called for creation of a health care cost commission while Republican lawmakers rallied behind proposals to rein in Medicaid expenditures as the simmering State House debate over health policy heated up.

Sponsored by Sen. Philip Bartlett of Gorham and Rep. John Brautigam of Falmouth, the Democratic plan — details were not immediately available — would be designed to curb health care cost increases, backers said.

According to Bartlett, 2004 health care costs in Maine were 19.4 percent of the gross state product, the second highest proportion in the nation.

“In short, we are on an unsustainable path that will deprive people of the opportunity to access affordable health care for themselves and their families,” Bartlett said. “Increasingly, health insurance is becoming unobtainable for working Mainers, leading to less preventive care and higher long-term costs.”

At one time, state government had a Health Care Finance Commission, which expired a decade ago.

Brautigam credited the Maine Quality Forum, an informational clearinghouse created as part of the Dirigo Health initiative, with some success but suggested a need for additional steps to make the delivery of health care more efficient.

At a news conference Tuesday, legislative Republicans led by Senate Minority Leader Carol Weston of Montville and House Minority Leader Josh Tardy of Newport touted several initiatives, including Weston’s efforts to provide a choice of health plans in the state’s Medicaid, or MaineCare, program and to institute co-payments and premiums for some of its 260,000 beneficiaries.

MaineCare is “being stretched to the breaking point here in Maine,” Weston said, calling the current system “unsustainable.”

Added Tardy in a statement: “In order to preserve this system for the most vulnerable residents of Maine, we need to make some changes so the program can survive.”

Baldacci, who has championed Maine’s Dirigo Health program to broaden access to health care and enhance its quality and affordability, is slated to unveil a new package of his own Wednesday afternoon.

“You can expect to hear something about cost, quality and access,” said Riley.

Last weekend, Baldacci released a statement for radio broadcast in which he pledged to build on accomplishments he has claimed for Dirigo and to tackle MaineCare costs.

“I am proud that four years ago we enacted the Dirigo comprehensive health reforms and much has been accomplished. The rate of the people who lack health insurance in our state has been better than the national average. But we must do more,” Baldacci said.

Saying that Dirigo would continue to grow moderately as the state moves toward universal coverage, Baldacci added, “We’re going to refocus Dirigo on enrolling the uninsured and the underinsured, and reduce costs for businesses to participate in the program.”

The governor also said he included ways to reduce MaineCare costs in his pending biennial budget package, such as “bringing the amount we pay for services more in line with other states.”

Baldacci also said adding a pharmacy co-payment for those who can afford it could be done “without cutting a hole in the social safety net.”

Last week, the Baldacci administration endorsed a revived attempt to let Dirigo Health’s board, rather than Anthem Blue Cross Blue Shield, design and market the state program aimed at extending affordable health coverage to the state’s uninsured.

The administration also announced its support for a separate bill before the Insurance and Financial Services Committee which would require health insurers to cover dependent children up to age 25.

The bills were recommended by a 15-member commission appointed by Baldacci to study the structure and financing of Dirigo Health. Last year, the Legislature rejected a Baldacci-backed proposal to allow Dirigo to be self-insured instead of contracting with Anthem.

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