Insurance pool eyed for state’s unemployed

AUGUSTA – Laid-off workers and retirees in the Millinocket area will lose their tenuous health care benefits April 29, but Trish Riley plans to have them covered.

Riley, the head of Gov. John E. Baldacci’s new Office of Health Policy and Finance, announced Friday afternoon that the first step of her plan to overhaul the state’s health system will be to provide insurance to the thousands of Mainers whose jobs and insurance have been lost because of foreign competition.

Though the process requires state lawmakers’ approval, Riley said she anticipates full support for the emergency legislation she hopes to have introduced within the next few weeks.

There are already 1,500 Maine residents qualified to join the startup insurance pool, and the Millinocket group affected by the bankruptcy of Great Northern Paper Inc. will add thousands more after the April 29 deadline.

These workers and retirees will buddy up alongside Maine state employees in a “shadow” pool that enables them to get health benefits similar to the state employees’ without actually joining their group. Anthem Blue Cross and Blue Shield provides coverage to the state employees group, and also will cover the shadow pool.

The plan is to offer participants coverage at rates similar to those enjoyed by state employees.

For laid-off workers, much of the cost of their new insurance will be paid through a U.S. Department of Labor fund established by the Trade Adjustment Assistance Act of 1974. The fund allows the state to receive up to $14 million to provide health insurance to laid-off workers or those whose hours have been cut by foreign competition. Workers using the funds have up to two years to find a long-term solution to their health coverage needs.

Riley has a plan for that as well. Up to $60 million in startup funding for innovative health coverage programs also is available to states through TAAA, first come, first served. So Riley and her team of advisers – many of whom traditionally have been in opposition on issues of health coverage – are united in a sense of urgency.

At the Friday afternoon meeting of the 30-member Health Action Team, Riley reviewed and took comments on progress made so far on crafting the nation’s first state-sponsored, nonprofit insurance program.

Although the still in the blueprint stages, Riley says, the new program, named Dirigo Health, will offer two alternatives to Maine residents and businesses.

Under one option, the Dirigo program would administer commercial carriers’ plans, using the clout of large-group policies to negotiate payments to health providers and drug companies. Riley said administrative costs would be kept to a minimum, and carriers would be offered incentives to practice effective disease prevention and management.

The second option envisioned by the Health Action Team is Dirigo Health’s own coverage, available to all Maine residents regardless of income or employment status, with premiums set on a sliding scale depending on family income. The plan would offer comprehensive coverage, including mental health, dental and vision care, and would provide higher payments to providers than current Medicaid plans allow.

Dirigo Health also will act as a “stop loss” program for commercial carriers, accepting a portion of all premiums and assuming the responsibility for paying out benefits over a certain level. This reduces carriers’ risk and keeps premiums low.

No express timetable has been set for the process of establishing the new nonprofit program, but Riley is clearly moving fast. When team members bog down in partisan back-and-forth over the many tangled strands of the process, it is Riley who pushes forward, crisply reminding them that this is not a process of consensus.

“The governor is absolutely committed to this process,” she said at the close of Friday’s meeting. “This simply is going to happen.”