The first two harsh-but-true statistics, compiled by Dirigo Health Reform, jump out as both stark and dismaying: Mainers spend more personal income on health care per person than 45 other states and Maine has some of the highest rates of cancer, heart and lung disease and diabetes. The next statistic is another heartbreaker: 130,000 Maine people lack even basic coverage – most work in small businesses or are self employed.
To address this problem, three years ago Gov. John Baldacci introduced the Dirigo Health reform legislation; after four short weeks of debate, the innovative plan was passed and signed into law on June 18, 2003. Anthem, the insurance company, signed a contract in September 2004 to administer the policy as “DirigoChoice” and the program went live in 2005.
How does this affect the waterfront community? “While anecdotally we know that many of these people live and work on the waterfront in small businesses, while we don’t know the precise number, addressing the needs of the waterfront community will continue to be crucial to covering the uninsured in Maine,” asserts Adam Thompson, legislative and constituent liaison for Gov. Baldacci.
After nearly three years, Dirigo has tallied some initial success statistics: 9,790 working Mainers, including 2,288 businesses are currently enrolled — these people were either uninsured previously or they carried health insurance cards with such a high deductible that for all intents and purposes, they were under-insured.
While one in eight adults remains without health insurance, a hearty 95 percent of these uninsured people are in the workforce, either actively working (80 percent) or looking for work (15 percent). “This goes a long way in defying the perception that the uninsured are not doing their part,” says Thompson.
Affordable and assessable insurance continues to be the goal of this health-care initiative. A Freeport oyster farmer who recently gave birth to her second child, Valy Steverlynck found her DirigoChoice policy a financial lifesaver. “Eric and I are extremely grateful that the state has taken the initiative to help families like ours meet their health insurance premiums,” says Steverlynck. “Dirigo is the only thing that stands between us and a major medical/catastrophic plan. Despite the fact that we have two young boys and care a great deal about their health coverage, we simply can’t afford a comprehensive health plan. Without Dirigo, we would be another uninsured family trying to pay for our four-month-old’s delivery – a very lengthy commitment for a family with limited finances such as ours.”
Promoting healthy living and substantially covering preventative care might well be the heart and soul of this program. Linell Mather, self-employed landscaper on Vinalhaven, said, “For me, Dirigo has been wonderful — I’m over 50, in good health and just received my first colonoscopy — with no bill — something that wouldn’t have happened with my previous insurance, which carried a high deductible for routine healthcare.”
“It’s nice to know that if something is bothering me I can afford to go to the doctor,” continues Mather. “Before I might wait days for some problem to get worse before seeking treatment, but now I get the problem checked out right away. Frankly, I don’t understand why more people aren’t signing up for this health plan.”
Selling off assets is not part of the plan, but confusion, like the paperwork necessary to enroll, could be described as a problem for many potential enrollees. The financial arrangement of the subsidy segment of Dirigo’s policy frequently confounds applicants, which is why part of Dirigo’s resources go towards helping people complete complex application forms. A plumber on Chebeague (who requested to remain nameless) only vaguely remembers her reasoning several years ago for rejecting DirigoChoice as a viable option — “Didn’t they want you to sell your house to qualify?” she muses.
While the answer to the plumber’s question is a resounding “no,” the plan does contain an option of receiving a discount — or subsidy — to offset the total cost of this health insurance policy. Applicants must complete complicated if not intimidating forms — first sending this paperwork to a state government office run under the auspices of MaineCare and then undergoing review for subsidy qualification. This potential discount remains a significant part of this health reform initiative.
In the good-news column, DirigoChoice appears to be saving Maine a considerable amount of money. Last fall Al Iuppa, the superintendent of Maine’s Bureau of Insurance ruled that Dirigo Health had saved $43.7 million for health care consumers. Cost containment elements include voluntary limits on hospital cost increases, a reduction in bad debt and charity care and an increased MaineCare reimbursement to providers (particularly doctors).
In Gov. Baldacci’s office, Adam Thompson explains that this subsidy is often the crux of any controversy about this innovative program. “For some people there’s an ideological difference of opinion over whether government should be involved in providing health care.”
Assessable and affordable remain the core buzzwords. “The subsidy program, which tries to reflect ability to pay, addresses the greatest barrier and makes Dirigo more affordable,” emphasizes Thompson.
Opinions and preferences differ, of course — not everyone who has reviewed this insurance policy became sufficiently enamored to sign up. Kelley Rich, administrator at Island Commons on Chebeague Island, said she reviewed DirigoChoice’s policy before selecting one put together by Aetna to cover her six employees. “I had looked into Dirigo, but it didn’t look cheaper than any other health plan and seemed to be based on your income — seemed appropriate for people with low income — and one thing that caught my eye was emergency room visit coverage, which seemed to be only 20 percent after the deductible had been met.”
To the naked eye, Dirigo’s initial information package, like most insurance packages, can appear to the consumer as perplexing, if not completely daunting. It’s not easy for everyone to come to the decision to sign up. “We looked into it and it seemed to us that the stipulations to get into it were a little too steep,” comments Vicki Todd, co-owner of Island Essentials, a small candle-making business on Chebeague.
The Maine legislature put up $53 million to get Dirigo Health Reform off the ground in 2003, and as of January 2006, $29 million remained in the program.
Anthem continues administration of DirigoChoice, but its contract with the state will expire at the end of this year; Maine legislators are actively reviewing all options to keep the program effective, if not with Anthem then with another equally suitable provider.
Useful Information
Questions About Coverage? Call Anthem Blue Cross and Blue Shield at 1-800-409-7520.
Applying for Coverage? (Employers and Self-Employed People) Call your insurance agent/producer or call Anthem Blue Cross and Blue Shield at the following numbers:
Employers: 1-800-541-4251.
Self-employed: 1-800-585-0099.
Individual: 1-800-585-0099.
Questions About Discounts? Call the Dirigo Health Agency at 1-888-243-8731 toll-free in Maine (207-287-9900). An on-line discount calculator may be found at www.dirigohealth.maine.gov/cgi-bin/dirigo/discest.pl.