Dirigo hailed as count of uninsured swells

By BART JANSEN, Portland Press Herald Writer

Copyright © 2004 Blethen Maine Newspapers Inc.

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WHAT IS DIRIGO HEALTH? Dirigo Health aims to cover all Mainers by 2009 through health plans that would be priced based on ability to pay. Subsidies would be available to people living under 300 percent of the federal poverty level - about $28,000 a year for a single adult and $56,500 for a family of four. The plans will cover comprehensive medical services, including prescription drugs and hospitalization, physician and specialist visits. Plans will also provide free preventive services - physicals, flu shots and mammograms. The program is the centerpiece of the state's Dirigo Health reform law, passed a year ago. The law also calls for measures to improve the quality of health care and contain costs. To top of story

WASHINGTON — Nearly 82 million Americans, including 290,000 in Maine, lacked health insurance at some point during a recent two-year period, says a consumer advocacy group that recognized Maine's Dirigo Health program as a pioneering effort to cover the uninsured. In a report released Wednesday, the group, Families USA, cited U.S. Census Bureau figures that paint a picture of the uninsured that is bleaker than that described by the federal government. The census figure most often quoted indicates that 43 million Americans lacked health insurance for all of 2003.

But the new study of 2002 and 2003 data found that another 39 million lost coverage at some point for as long as nine months.

"One out of three non-elderly Americans without health insurance constitutes an enormous epidemic that requires serious and immediate action," said Ron Pollack, executive director of Families USA.

Because four out of five of the uninsured belong to working families, the problem is moving into the middle class and showing up on political radar screens. Republicans and Democrats in Congress have offered dueling visions for coping with the problem, with no sign of action.

In a news conference at the National Press Building, Pollack singled out as a model Maine's Dirigo Health program, which is named after the state's motto, meaning "I lead."

"Maine's proposal is a truly historic effort that might have significant ripple effects all across the nation," Pollack said. "Dirigo could potentially be a model for what other states and the federal government could be doing to expand coverage."

Gov. John Baldacci, who previously served four terms in the U.S. House, attended the news conference. He noted that states also led the federal government in providing care for indigent children and for treating mental ailments.

"It was just very frustrating, having been here for eight years and not be able to address those issues," Baldacci said. "We needed to control costs and at the same time improve access."

In Maine, unpaid medical bills and charity care totals 16 percent of medical costs, about $275 million, Baldacci said.

The goal behind Dirigo Health is to give the uninsured health care so they prevent health problems or treat them sooner, to save money for hospitals, insurers and customers. The plan approved by the Legislature aims to cover all of the state's uninsured within five years.

The program, which was supposed to start July 1, is behind schedule. Only one insurer, Anthem Blue Cross Blue Shield of Maine, is bidding to provide the coverage.

If selected, Anthem could start signing up customers in October and start providing coverage in January. Subsidized policies would be available to customers who earn as much as three times the national poverty level - about $28,000 a year for an individual and $56,000 for a family of four.

Dirigo Health aims for premiums to start at $169 per month. Employers are supposed to pay 60 percent of the cost, with workers paying a share according to household income. The deductible would range from nothing to $1,250, depending on income.

More than 150 businesses and advocacy groups statewide stepped forward this week to promote the program under the banner of a Web site, www.dirigohealthnow.org.

But critics, including the conservative think tank Maine Heritage Policy Center, questioned the benefit of the program for employers.

State Rep. Chris O'Neil, D-Saco, chairman of the Legislature's Insurance and Financial Services Committee, called the program "deeply flawed," but said it could provide coverage for some people who wouldn't otherwise get it.

He argued that many employers can already get insurance at comparable costs, but that it will appeal to the highest-risk customers facing the highest premiums. The problem is that if too many costly customers show up, the program could become prohibitively expensive.

"It would be like putting 10,000 people in a row boat," O'Neil said.

Staff Writer Bart Jansen can be contacted at 202-488-1119 or at:

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