|
Tuesday, August 24, 2004
Dirigo plan sign-ups start in fall
Copyright © 2004 Blethen Maine Newspapers Inc. | ||||||
 |
Also on this page: In Depth: Health Care Reform | |||||
AUGUSTA — Starting in early October, low- to middle-income Mainers can sign up for health insurance priced on ability to pay through an ambitious public- private partnership being watched closely by other states. The program will take effect Jan. 1 as part of Gov. John Baldacci's bid to extend affordable health care to more than 130,000 Mainers without insurance and reduce the high costs resulting from uninsured people visiting emergency rooms as a last resort. To administer DirigoChoice, the state Monday agreed to a contract with Anthem Blue Cross and Blue Shield of Maine after nearly two months of negotiations amid grumblings that Maine's largest insurer is becoming a monopoly. "Today we mark a huge step towards our goal of universal access for all Maine people," Baldacci said at a Monday news conference. "I want to thank Anthem for coming to the table." DirigoChoice is a key program of the Dirigo Health Reform Act, which drew national attention for trying to increase access to health care while improving its quality and lowering its cost. The program's success, however, rests on whether small businesses, DirigoChoice's prime market, will sign up. DirigoChoice is priced comp- arably to plans already available: A single employee would pay $310 a month for a premium; an employee with a family of any size would pay about $930. The premiums are higher than the Baldacci administration quoted earlier this year because they take into account medical inflation rates, officials said. But DirigoChoice "offers more value for your dollar," said Trish Riley, director of the Governor's Office of Health Policy and Finance and an architect of DirigoChoice. First, a person who makes less than $27,930 or a family of four that earns less than $56,550 would qualify for discounted premiums and reduced deductibles on a yet-to-be-announced schedule. Administrators said their plan differs because of its strong focus on wellness and personal health management. DirigoChoice completely covers preventive services such as smoking cessation, pap smears and baby checkups. Enrollees are paid $100 to pick a primary care physician with whom they can work on health goals, such as weight loss. Also, DirigoChoice will be the only insurance product in Maine for small groups and individuals that offers mental health parity, meaning that certain services must be covered like a physical ailment. The first-year plan is to enroll up to 31,000 Mainers through their employers, and 5,000 individuals who are self-employed or unemployed. Riley said it's unlikely that the 31,000 limit will be surpassed, but that individuals appear to be highly receptive to DirigoChoice after years of paying for high-deductible plans, or "catastrophic care." Because individuals who apply for coverage tend to be sicker and require more services, a cap is needed, Riley said. Officials will decide in the coming weeks whether to accept the 5,000 on a "first-come, first-served" basis or to base enrollment on geography to ensure that people from all over the state are covered, she said. Rep. Kevin Glynn, R-South Portland, is among the legislators who voted for the Dirigo Health reforms last year but now say that DirigoChoice is falling short of expectations. The fact that needs-based enrollment for individuals is not being considered is troubling, he said. "The promise of Dirigo was that it was going to provide health insurance to people who could afford it the least," Glynn said. Glynn said he was also concerned that Anthem's contract for DirigoChoice unnecessarily protects the company from unexpected losses. The company, Glynn said, already administers the state employee health plan and controls the private health insurance market and is, effectively, a monopoly that is scaring away other insurers from coming to Maine. Anthem, the only major insurer in Maine to bid on DirigoChoice, acknowledged it did so as a business move but also as a way to support Baldacci's goal of expanding health care access. Anthem's licensed network of brokers will sell DirigoChoice alongside the traditional line of products, but spokesman Bill Cohen said he didn't see a conflict of interest. "The strength we bring to the table is that we have a whole array of products and now Dirigo is one of them and, in this particular case, is aimed at small businesses and the uninsured," Cohen said. About $500,000 in bonuses will be given to brokers who bring in previously uninsured business over a two-year period, he said. DirigoChoice was scheduled to start July 1, but officials said developing such a unique program forced delays. Anthem said it needed until Jan. 1 to set up information technology systems able to handle DirigoChoice's complex funding mechanism. The program is to be sustained by contributions from employees and employers, who are required to pay 60 percent of their employees' coverage. Also, the state can draw down federal dollars for DirigoChoice enrollees whose income is low enough to make them MaineCare-eligible, and for its first year, can use $52 million in startup funds allocated by the Legislature. Next year, the state plans to show that the reforms of the Dirigo Health Reform Act are taking effect, and will start to charge insurers a fee to go toward DirigoChoice that will reflect those savings. Staff Writer Josie Huang can be contacted at 791-6364 or at: jhuang@pressherald.com
|
||||||
