Corralling the health care crisis

A recent front-page story in the Bangor Daily News reported that Medicare premiums were increasing 17 percent, the largest monthly jump in the program’s 40-year history. The rise is attributed to rapidly increasing health costs. In 2003 premiums increased 8.7 percent and jumped again – 13.5 percent – in 2004. Vulnerable elderly and disabled Americans are now joined by growing ranks of middle-class employees and employers who cannot afford health insurance.

During our door-to door campaigns, we met with hundreds of citizens of all ages and all walks of life. Their most frequently raised concern is that health insurance is becoming so expensive that it is compromising the quality of life and financial security of hard-working citizens and their families. Health care costs, coupled with property tax increases and rising transportation and child care costs require families to skimp on basic needs.

Today Maine has the highest number of uninsured people in New England and one of the highest uninsured rates in the country – 180,000 according to recent studies. Eighty percent of these uninsured are people who work for small businesses or are self-employed. Ironically, more money is spent on health care in Maine than in most states even though we rank 35th in per capita income. Although Maine has high-quality health care with its hospitals ranking third in the nation, more Maine people die each year of preventable diseases – partly because they cannot afford health care and partly because of life style choices and a lack of emphasis on preventative care.

Gov. Baldacci and his staff worked tirelessly to create Dirigo Health, a plan that will provide health benefit coverage at much more affordable rates for all Mainers. The plan supplies insurance for individuals and businesses with 50 or fewer employees by pooling funds and brokering health insurance coverage on the one hand, while controlling costs and promoting healthier lifestyles and preventive health care on the other.

Wellness incentives are part of the Dirigo design with 100 percent of preventive care services, including smoking cessation, a benefit of the plan. This means that there is no co-pay for preventative care services. None. This is a big leap and one that addresses a monumental roadblock to keeping Maine healthy. No one is excluded because of a pre-existing condition, and the program reimburses members for a health risk assessment when they select a primary care physician. Access to many wellness services and benefits, such as discounts at health clubs, for bicycle helmets and consulting services that promote workplace health will be available. The emphasis again is on disease prevention and early treatment for health problems to avoid costly acute care.

To ensure that previously uninsured people can acquire health care, not only will rates be as low as $310 a month for a single individual when the program is launched, but a financial discount program in which deductibles will vary based on ability to pay will help employees and individuals afford quality health care. Exact discount rates will be available in October, when sign up for the program will be available. Implementation of Dirigo is scheduled for January 2005 with coverage limited to small business and the self-employed during the first quarter and then opening up to individuals during the second quarter.

These objectives will require cooperation from all segments of the health care industry.

Under the Dirigo plan, $30.5 million of the $275 million spent each year in hospital charity care will be eliminated in the first year alone. Special provisions are being added to ensure the continued viability of rural hospitals such as ours. Amendments are also being drafted to clarify the Legislature’s role in reviewing compliance with the plan and to address some of the Maine Hospital Association and Maine Medical Association’s concerns.

The public-private collaboration that produced Dirigo Health represents a genuine effort to make health care available at more affordable costs. The Maine Small Business Alliance is holding a series of public information forums on Dirigo in Hancock and Washington Counties from Sept. 20-22 and will continue do to so throughout the state. Please attend the forum closest to you to learn more about this promising health care program.

On Monday forums will be held in Bucksport at the town office from 10 a.m. to 11:30 am and in Ellsworth at City Hall from 2:30 p.m. to 4 p.m. Tuesday’s forums will be held in Machias in the University of Maine Science Building from 8:30 a.m. to 10 a.m., in Lubec at the Municipal Building from 1 p.m. to 2:30 p.m. and in Eastport at Shead High School from 6:30 p.m. to 8 p.m. Wednesday’s forum is in Calais in the Assembly Room at Washington County Community College from 9:30 a.m. to 11 a.m.

For more information on the Dirigo Health Plan visit www.dirigohealth.maine.gov

Rep. Ted Koffman, D-Bar Harbor, is House chair of the Natural Resources Committee. Rep. Anne Perry, D-Calais, is a member of the Health Care Reform Committee, which set up Dirigo, the Health and Human Services Committee and the Insurance & Financial Services Committee.