Forum speakers raise concerns over Dirigo

BANGOR – Bangor’s business community turned out in force Tuesday morning to get the lowdown on Gov. John. Baldacci’s Dirigo health reform initiative. What they heard was a distillation of many of the arguments used against Dirigo during the recent legislative session.

Presenters included representatives of the hospital, insurance and business communities – stakeholders that wrangled the hardest with the governor and his appointees during the last legislative session as Dirigo worked its way toward approval.

Speakers at the informational forum, co-sponsored by Eastern Maine Healthcare and the Bangor Region Chamber of Commerce, said they support Dirigo’s reforms now that they are incorporated into Maine law. But most of the points raised focused on potential difficulties. Several audience members criticized the absence of representation from the Governor’s Office of Health Policy and Finance to counter the negative presentation.

Dirigo seeks to provide affordable health coverage for all Maine residents. It calls for expansion of the MaineCare program and an infusion of federal Medicaid dollars. It requires commercial insurers to pay a portion of their profits to the Dirigo budget to subsidize low-income enrollees in a specially designed insurance plan.

Employers who elect to offer the coverage to their workers will pay 60 percent of the premium. Employees will pay the balance with assistance from the sliding-scale subsidy.

Provisions in the law also place voluntary limits on hospital profits, control medical system spending and expansion and tighten regulations on the insurance industry.

David Clough, state director for the National Federation of Independent Businesses, said during the forum that Dirigo has the “potential to be costly and cumbersome” for employers. Although the precise benefit mix and cost of the plan has yet to be determined, Clough said it is “doubtful how many small businesses will be able to afford it.”

Clough also questioned Dirigo’s funding formula, and said there never had been an independent financial analysis of the plan. “Will Dirigo work as designed?” he asked. “There’s a lot of skepticism.”

He raised a number of unknowns to highlight his point:

Will the Legislature focus on making Dirigo work, or will they make improvements to the competitive insurance market? What will happen if employers don’t buy into the plan? What if the Medicaid match falls short? Are employer mandates the next step? Should Mainers trust the Department of Human Services to manage complicated financial transactions, in view of recent problems?

Flashing the skewed-perspective illustrations of artist M.C. Escher on the presentation screen, Clough said, “It all depends on how you look at it.”

Dr. Daniel Fishbein, general manager of Aetna Insurance and chairman of the Maine Association of Health Plans, echoed many of Clough’s comments and said solutions that promise simple fixes to the complicated health care system should be viewed with skepticism.

“As Americans, we don’t like to be told what to do,” Fishbein told the audience. “Especially by the government.”

Mary Mayhew, vice president for government affairs and communication at the Maine Hospital Association, said: “Hospitals might as well have been equated with Enron,” during the Dirigo debates. “I take offense at that,” she said.

Mayhew acknowledged that hospitals are “part of the problem” but said complying with voluntary caps may limit services, delay new technologies and eliminate community wellness programs such as smoking cessation.

During the brief opportunity for questions after the presentations, at least three audience members expressed concern that no one was present from the Governor’s Office of Health Policy and Finance.

David White, a Bar Harbor small-business owner who has participated in and supported the Dirigo process from the beginning, said that based on the “bleak picture” presented, “I wouldn’t want to buy or invest in Dirigo.” He criticized the lack of balance and accused presenters of continuing to argue against the reforms despite their professed support.

After the event, Jerry Whalen, EMMC vice president of business development, said there was no effort to eliminate viewpoints from the forum. There are not two sides to the issue, but “dozens of diverse interests trying to move in the same direction,” he said.

Acknowledging that more than a dozen written evaluations submitted at the end of the program suggested the need for more balanced information, Whalen said future forums might include Trish Riley, director of the governor’s health office and primary architect of the Dirigo legislation.

EMH will take its Dirigo presentation on the road this week, with stops in Presque Isle, Waterville and Pittsfield.