Why change Dirigo when it’s working?

Dirigo Health is working. In all the discussion and debate about this new state program, we should not lose sight of this important point. The major goals of Dirigo are to provide comprehensive health insurance to Mainers who now lack coverage; to achieve savings within the health care system that can be reinvested to cover even more people; and to maintain and improve the quality of health care in our state.

When we voted as legislators in 2003 by large bipartisan majorities to establish Dirigo Health, we were warned not to expect an instant turnaround. It takes time to reform anything as large and complex as the public-private system we use to deliver health care, yet within two years we are seeing results.

Thousands of Mainers who had no insurance, and many more whose insurance was inadequate, now have full access to health care through Dirigo. As a result, Maine is among only a handful of states where the number of citizens with insurance has gone up, and not down. While New Hampshire, Vermont, Rhode Island and Massachusetts had significant increases in their uninsured population from 2000-04, Maine did not.

We now know that in its very first year of operation, Dirigo saved nearly $44 million for the benefit of health care consumers. And with the advent of the Dirigo Quality Forum and Maine’s first statewide health plan, we are well on the way to ensuring health care quality for all our citizens.

There have certainly been plenty of differences of opinion about numbers, percentages and dates for the program. It is legitimate to discuss how many people should be insured each year, and how the program is financed and overseen. But we shouldn’t let those differences obscure Dirigo’s significant accomplishments and successes.

For instance, the Dirigo Health board is now discussing how much of the $44 million in savings certified by the Superintendent of Insurance should be used to finance the program next year. The answer is to use all the savings for that purpose. If the goal is to insure the uninsured and the under-insured, then we should expand the DirigoChoice insurance program as much as we can within the available financing.

We should take the same approach to any changes suggested for Dirigo. Some of our Republican colleagues have said they want to “save” Dirigo by removing some of the basic guarantees we have for access to private health insurance. We have to disagree. We are never going to reach our goal of universal access to health care if we make insurance accessible only for Mainers who are young and healthy.

It is precisely those who are getting older, or who are in poor health, who most need regular access to health care. We will accomplish nothing by making it impossible for them to maintain coverage. Establishing a high-risk pool, as some have suggested, runs into the same problem – as it did when Maine had a high-risk pool before it decided, instead, to guarantee access to insurance for everyone. Here and in other states high-risk pools do not insure more than a tiny number of people, and soon become so expensive they require taxpayer subsidies – something Dirigo Health is specifically designed to avoid.

We should also recognize that Dirigo is not just a state program. It is a cooperative effort that requires work from all parts of the health care system – not just the state, but employers, insurers and health care providers. We rely on providers to deliver health care more efficiently, which they’ve had some success in doing. We depend on health insurers to realize those savings in the rates they charge their customers. And we need state government to create the health care plan, and to oversee the system, in a way that helps it all fit together.

Before we vote for any changes in Dirigo, we should ask whether it would serve the goals of increasing coverage, containing costs and improving quality. Unless those tests are met, in practice and not just in someone’s theory, then we should let the program work within its original design, with recent amendments agreed to by all parties.

No one said this would be easy, and it is not. No one said it would happen overnight, and it didn’t. But we can be proud that in Maine, there is a health care plan known as Dirigo Health that is making a difference, and can achieve its goals if we are willing to stick with it.

John Richardson, D-Brunswick, is the Speaker of the Maine House of Representatives and represents House District 63, part of Brunswick. Rep. Anne Perry, D-Calais, is the House chair of the Insurance and Financial Services Committee, which oversees Dirigo legislation, and she represents House District 31.