Maine Health Care Overhaul Offers Lessons for States
Enrollment in Dirigo Health, a Maine health insurance program that seeks to provide coverage for the estimated 130,000 uninsured state residents by 2009, has fallen short of targets, the New York Times reports (Belluck, New York Times, 4/30).
The public-private health insurance program, established under a state law enacted in 2003, offers lower-cost health plans to self-employed individuals and to employees of small businesses. Under the program, the state contracts with private health insurance carriers and competes with current health plans to offer coverage to employees who work at least 20 hours per week.
Employers cover as much as 60% of the cost of the premiums, and employees pay the remainder of the cost. The state provides premium subsidies on a sliding scale to program participants with annual incomes less than 300% of the federal poverty level.
The state offers employers subsidies to encourage the participation of employees who meet certain criteria (California Healthline, 6/19/03).
The state sought to enroll 31,000 uninsured residents in the program by the end of 2005. However, to date only about 18,000 state residents have enrolled in the program, and many of them previously had coverage.
According to the Times, the problems with enrollment in Dirigo Health are related to some "particular challenges" that Maine faces. Maine has large rural, low-income and elderly populations with significant health care needs; a large number of small businesses and part-time or seasonal workers, and few employers that can voluntarily offer health insurance to employees.
In addition, most private health insurers do not offer individual coverage in Maine, "leaving one carrier, Anthem Blue Cross Blue Shield, with a majority of the market, a landscape that some economists said could make it harder to provide broad choices and competitive prices," the Times reports.
However, according to the Times, several parts of the program "are seen as promising," such as the formation of a state watchdog group to promote improved health care quality and an effort to reduce hospital costs. The "story of Maine's health programs ... harbors lessons for the country, as covering the uninsured takes center stage," the Times reports.
Maine Gov. John Baldacci (D), who has proposed a number of revisions to the program, said, "I think when we first started, in terms of making estimates, we really were kind of groping in the dark" (New York Times, 4/30).