Why seven-point prescription misses the point

Sen. Peter Mills’ “Seven-point prescription to cure DirigoChoice” (BDN op-ed, Feb. 16) offered few suggestions to strengthen DirigoChoice but much in the way of proposals to weaken the program. This also was a perfect illustration of the misinformation campaign being waged by Maine’s Republican Party and the health insurance industry in an attempt to sabotage one of Dirigo health’s most important components, DirigoChoice.

DirigoChoice was created to address the health care crisis in this state and provide good health care to Maine citizens. This will not be accomplished by eliminating consumer protections, forcing Maine citizens into ineffective health care plans, keeping sick people from signing up for health insurance, and subsidizing the health insurance industry.

According to a Harvard University study of 1,771 respondents who were forced into bankruptcy nearly half indicated that a medical catastrophe was the cause of their bankruptcy. Three-fourths of those individuals actually had health insurance. Yet Sen. Mills seems content to keep Maine citizens with health insurance plans that have high deductibles, and cost caps from enrolling in DirigoChoice. Furthermore, these plans do not provide for preventative care procedures such as colonoscopies and mammograms. He seems bent on trying to keep people from enrolling in DirigoChoice which offers low deductibles, preventative care and covers the high costs associated with a major medical catastrophe.

Sen. Mills’ proposal to keep sick people from signing up for DirigoChoice by allowing carriers to impose a waiting period on individuals with pre-existing medical conditions would allow insurance providers to keep sick individuals from having health insurance when they most need it. It is amazing to think that the GOP plan for making Maine a healthier place is to force sick people to wait for health insurance until the provider sees fit to let them sign up for coverage.

One of the most high-profile issues associated with the Dirigo debate is the Savings Offset Payment (SOP). This provides that savings realized by the insurance industry as a result of Maine’s initial investment to provide coverage for uninsured and under-insured people will be paid back to the state in the form of an SOP. As a result of an exhaustive hearing in which all stakeholders in the Dirigo program had a chance to state their case, Maine’s superintendent of insurance ruled that insurers had benefited from savings provided by Dirigo to the tune of $43.7 million.

Though Anthem is currently realizing record profits and has benefited from increased enrollment as a result of Dirigo, it does not feel that it, along with fellow insurers, must pay this money back to the state. Furthermore, if these insurers do pay the money back to the state they intend to pass the buck on to average Mainers in the form of higher premiums and call it a “tax.”

Sen. Mills seems satisfied with the insurance industry’s collective stance and suggests that we should find an alternate source of revenue to pay for Dirigo; namely taxpayer dollars. In this case the priorities of the Maine GOP and Sen. Mills seem backward. Shouldn’t we be providing subsidies to hard-working Maine citizens for affordable health insurance and not to out-of-state insurance companies that can afford to provide $40 million bonuses to its CEO?

Though this seven-point prescription to fix DirigoChoice dealt mainly with DirigoChoice, Sen. Mills alluded to another goal of the health insurance industry and the state Republican Party, which is to eliminate the consumer protections that Maine provides for its citizens in regard to eligibility for health insurance. These protections make it possible for sick and elderly Mainers to have access to health insurance regardless of their situation. These protections provide for community ratings that charge a fair rate for all individuals in a community and don’t discriminate based on age or other factors.

Finally, Sen. Mills suggests that market competition would be a healthy addition to DirigoChoice. I could not agree more. This is why Sen. Mills should be in favor of LD 1845, a bill currently under consideration to allow the state of Maine to explore all options when its contract with Anthem is over at the end of 2006. By providing our lawmakers with some leverage and wiggle room to negotiate a new contract or seek alternate means to provide the DirigoChoice product to Mainers, Sen. Mills’ idea of more market competition may be realized.

DirigoChoice is working for Mainers. Currently more than 9,000 people who did not have health insurance or were underinsured now have comprehensive and affordable health insurance thanks to DirigoChoice. Providing subsidies to the insurance industry with taxpayer-funded programs, eliminating consumer protections and keeping the sick and underinsured from signing up for DirigoChoice will not strengthen DirigoChoice or provide for the health of Maine citizens.

Making the insurance industry live up to its end of the DirigoChoice agreement and continuing to provide quality health care to Mainers through DirigoChoice will ensure a bright future for our state.

Charles Urquhart, of Brewer, is a member of the Maine People’s Alliance.