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Saturday, January 1, 2005
Opinions differ on health plan
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Gov. John Baldacci's nationally touted health insurance program swings into effect today with 1,800 Mainers signed up as the first card-carrying members of DirigoChoice. Whether that's cause for celebration depends on whom you ask. At Inn by the Sea in Cape Elizabeth, 100 percent of the full-time staff will have health insurance for the first time, said general manager Laurie Inness. The coverage, Inness said, is as good as the old Aetna plan and, unlike other private plans, provides discounts to some of the 18 inn workers who qualify. The program also is helping the Democratic governor reduce the ranks of the uninsured, individuals who are more likely to suffer poor health because they don't get timely help, and often end up costing the health-care system with bad debt or charity care. "This is a step toward solving not just a state problem but a national problem," Inness said. But skeptics said the number of people enrolled in DirigoChoice so far does not bode well for its future, considering that the Baldacci administration wants to enroll 31,000 people by the end of 2005. "I think based on their projections, they're failing miserably," said Tarren Bragdon of the Maine Heritage Policy Center. The politically conservative think tank sees DirigoChoice as a poorly conceived plan. It prefers free-market ideas for lowering health-care costs such as deregulating health insurance. In the year ahead, skeptics will search for holes in the program. Supporters will do what they can to help the governor make good on his pledge of universal health care in five years. Yet everyone has the same questions: Will more people sign up? How many of them were previously uninsured? Will there be enough money to run the program? DirigoChoice, administered by Anthem Blue Cross and Blue Shield, is using most of $52 million in start-up funds, allocated by the Legislature, to offer subsidies to Mainers who make as much as three times the poverty level - $28,000 a year for a single person or $56,550 for a household of four. But that pot of money will not be replenished. So a year after DirigoChoice is launched, the program's coordinators plan to levy an annual fee on insurance carriers. The fee will be calculated by figuring out how much DirigoChoice saves the health-care industry. Proving the savings to insurers, however, could be a challenging task. Revenue for the program also will come through MaineCare, the state's version of Medicaid, the state-federal insurance program for poor and disabled people that is being expanded in April. For every state dollar spent on MaineCare, the federal government contributes $2. The Baldacci administration hopes employers will enroll MaineCare-eligible people in DirigoChoice and draw down federal dollars. Detractors, however, are urging the federal regulators to check the legality of such a move. The program, too, faces the challenge of convincing employers to pay monthly costs for someone who could get free care through MaineCare. DirigoChoice says doing so would assure workers affordable coverage even if they are bumped off the MaineCare rolls. Such employees also would be on the same insurance plan as their co-workers, and have access to the same health-care providers. Furthermore, DirigoChoice's fiscal success hinges on how successful it is at capturing its target market: small businesses with two to 50 employees, where many of Maine's 130,000-plus uninsured people work. The program can't afford to cater to individuals, who tend to be sicker and more costly to cover than groups. It appears that more outreach to small businesses is needed. Self-employed subscribers and their dependents make up the bulk of new members, with 1,145 people. The 133 participating small businesses have 655 employees and their dependents. Critics say the response shows that DirigoChoice is not affordable enough. Without subsidies, a single person would have to pay about $287 monthly for a plan with a $1,750 deductible. A family would have to pay $860 for the same type of plan. Karynlee Harrington, executive director of the Dirigo Health agency, acknowledged that the enrollment numbers were "slightly lower than expected" but cited different reasons. It takes time, she said, for small-business owners to decide whether they can make the minimum 60 percent employer contribution required under DirigoChoice or find enough employees willing to participate. The fact that the program missed its original start date of July 1 also may have cost it some clients who didn't want to wait, she said. But Harrington was upbeat. "I think we're off to a solid start. We will continue to do the things we need to do to promote the program and to make sure people understand the value of the program." The program offers 100 percent coverage for preventive services such as check-ups and mammograms, and equal coverage for mental health ailments. For income-eligible members, discounts can be applied to monthly costs, deductibles and co-payments. Harrington expects to see interest spike when radio and print advertisements resume this week. More Mainers, she added, may enroll after they find out whether they qualify for Medicaid under the expansion in April and can join DirigoChoice for free. Harrington said it's unknown how many enrollees so far were previously uninsured. A survey of members will be conducted this month, she said. Staff Writer Josie Huang can be contacted at 791-6364 or at:
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