Get facts straight on DirigoChoice

You recently ran an op-ed titled, “Dirigo health plan a disappointment,” that, unfortunately, was inaccurate. While we know that Tarren Bragdon and the Maine Heritage Policy Center have never supported Dirigo Health Reform, we think it’s important to get the facts straight.

Even though DirigoChoice coverage has only been active since Jan. 1, Bragdon and the Heritage Center suggest it is failing and that “small businesses are rejecting” it. To the contrary, more than 3,000 Maine people have already enrolled in DirigoChoice. They come from more than 250 small businesses and 1,000 sole proprietors. And, applications keep coming in every day. Starting Feb. 1, individuals are able to enroll.

DirigoChoice was designed with considerable input from the private sector. Guidance from small businesses and focus groups with employers helped to assure the program would meet their needs. The key staff responsible for program design had all recently left private business to help with the plan.

We heard from small businesses that even when they offered health coverage, many employees could not afford it. As a result, we decided to subsidize the employee share of the program’s costs.

Far from being “inflexible,” as Bragdon wrote, the cost of DirigoChoice reflects employees’ ability to pay. DirigoChoice provides discounts to help employees afford coverage. It is the only plan with such flexibility in its costs. Discounts are based on household income, in order to reflect an employee’s ability to pay. Even daycare costs can be subtracted from one’s income when determining discount eligibility.

DirigoChoice and its discounts are a new approach to expanding access to coverage. Anything new brings with it questions and the need for information. DirigoChoice is provided by Anthem Blue Cross and Blue Shield and looks very much like other products in the market. However, it has additional benefits, like the discounts, that are rarely found in other insurance products. Along with coverage for hospital, physician and specialist visits and prescription drugs, the added benefits include:

?100 percent coverage for preventive care – no co-pays or deductibles when members get preventive care such as routine physicals, mammograms, well-baby care, certain blood tests, PAP tests, and more;

?Coverage for mental health needs at the same level as physical health;

?No pre-existing condition exclusions – pre-existing conditions are covered from day one;

?The Healthy ME Rewards program which gives members $100 for choosing a primary care doctor and completing a health needs assessment. Employers who had not previously offered coverage will get up to $1,500 if enough of their employees participate in Healthy ME.

Insurance by nature is complex. Navigating all the products in the marketplace to determine which to purchase and then completing the paperwork can be a hassle for employers. Not surprisingly, Bragdon suggested DirigoChoice is “the most complex health plan on the market” in order to dissuade employers from looking into it. In fact, DirigoChoice offers two plans that differ only on monthly costs and deductible amounts. The Dirigo Health Agency takes on the job of determining discount eligibility so that employers don’t need to deal with it. And, employee privacy is protected.

Employees submit a discount application directly to the Dirigo Health Agency. Confidentiality is strictly preserved and staff from the Dirigo Health Agency are available to help complete the short application. (If your readers wish to know whether they qualify for discounts they should look up the DirigoChoice Discount Estimator online at www.dirigohealth.maine.gov.)

Discounts range from 100 to 20 percent of monthly costs and deductibles. By combining the discount program with the MaineCare program we are able to offer 100 percent discounts to lowest wage workers. Workers who qualify for MaineCare can receive their MaineCare benefit through DirigoChoice. They get the same health plan other employees in the company get but they get a deeper discount and some added MaineCare benefits. And, if they become ineligible for MaineCare, they will still have coverage through DirigoChoice, with just a smaller discount.

DirigoChoice is the first step in the broader Dirigo Health Reform. We are working hard to bring down health care costs in Maine and make our State the healthiest in the country.

Despite the vocal criticism of a few naysayers, Maine’s small businesses, sole proprietors, and individuals are signing up for DirigoChoice in every County in Maine. That may be a disappointment for those who oppose Dirigo Health Reform, but for those who want action to make health coverage more affordable for all Maine citizens, DirigoChoice is already succeeding. Just ask all the people who have enrolled.

Trish Riley is director of the Governor’s Office of Health Policy and Finance. Karynlee Harrington is executive director of the Dirigo Health Agency.