State unveils CareWorks health plan

AUGUSTA – Gov. John Baldacci and his Dirigo health care reform team rolled out the state’s long-awaited health insurance plan Thursday at the State House.

Dubbed “CareWorks,” the plan promises comprehensive coverage at a relatively affordable price and is aimed initially at providing coverage to individuals, the self-employed and uninsured employees of small businesses.

Coming at a time when state lawmakers are embroiled in heated negotiations over deep cuts in Medicaid services, CareWorks represents a long-term commitment to improved health care, the governor said. “We’re facing difficult budget decisions. Our current [Medicaid] budget is a symptom of Maine’s high health care costs. Dirigo invests in Maine and is insurance against rising health care costs,” Baldacci said.

The plan will offer some unusual perks, including health club discounts and financial incentives to stop smoking and lose weight, as well as income-based premium discounts and a sliding scale of out-of-pocket expenses. Preventive care such as well-child checkups, flu shots, mammograms and routine physicals will be covered 100 percent with no out-of-pocket cost to participants.

As outlined Thursday, CareWorks would cost as little as $282 a month for a single employee, or $846 for an employee, spouse and children. Employers, many of whom say they can’t afford the expense of pricier plans, will be required to pay 60 percent of the premium if they choose to offer the benefit to their workers.

David White, a small-business owner from Mount Desert Island, said many business owners want to provide employee insurance as a way to attract and retain a stable and qualified work force. “In the big picture, they pay for their employees’ health care anyway,” he said, through increased taxes and their own insurance premiums.

Joe Ditre, director of Consumers for Affordable Health Care, said CareWorks “turns the concept of insurance on its head” by offering coverage based on ability to pay and by providing direct incentives to adopt healthy behaviors. “I see this as a health system, not just an insurance product,” he said.

The state hopes to enroll about 30,000 Mainers in the first year CareWorks is offered, beginning this summer. The plan will expand in the future, with a goal of insuring many of the approximately 180,000 state residents who currently have no coverage. CareWorks also expands eligibility for Maine’s Medicaid program, called MaineCare, to about 14,000 additional residents. People who are eligible for MaineCare can also enroll in CareWorks.

The CareWorks plan was developed in consultation with employer and employee focus groups, insurance companies and national marketing experts, said Dr. Robert McAfee, chairman of the Dirigo board. While the state will provide oversight and administrative services, the plan is expected to be offered through a private insurance company and will be put out to bid in about a month, he said. CareWorks is designed to be competitive with other insurance products and to provide a profit to the company awarded the contract, McAfee said.

Katie Fullam-Harris, who represents Anthem Blue Cross and Blue Shield, said Thursday that Anthem will analyze the request for proposals when it is issued to determine whether it can incorporate CareWorks into its product line. Other likely bidders include Cigna Healthcare and Aetna Insurance. Any insurer, including companies not currently doing business in Maine, may bid on the contract.

If a suitable contract cannot be negotiated, state law directs the Dirigo board to establish a nonprofit entity to provide the coverage.

More information on the Dirigo Health plan is available at www.dirigohealth.maine.gov