OUT OF THE DIRIGO DEBATE

The one saving detail of the Dirigo health proposal approved by the Senate last week and awaiting a House vote later this month is that the program wasn’t killed outright. Otherwise the deal is as close as possible to giving up on finding health care savings and expanding care without actually doing so.

Instead of collecting from insurers what the superintendent of insurance agreed was the amount Dirigo saved last year, $43.5 million, lawmakers agreed to let the system collect $23 million. The bill does reassert that there are savings in the health care system, but now the number is based on political compromise rather than the hearing process originally created to treat all sides fairly.

The amendment would also allow the state to use $11 million it would otherwise set aside to account for risk to the plan’s administrator, Anthem Blue Cross-Blue Shield. Almost comically, it demands an additional $1.9 million in savings from Dirigo administrative costs – lawmakers and others have engaged Dirigo administrators in prolonged and complex debate, requiring a huge amount of time and energy, and now essentially complain that the agency responded.

A sign of hope in all this is a commission to look into the long-term funding of the plan. Commissions, even blue ribbon ones as has been proposed for Dirigo, are usually what emerge when lawmakers don’t want to act. In this case, a commission should be seen as an opportunity for obtaining much more information about why health care costs are so high in Maine.

This is not a new topic, but it is the key to arguing for or against the savings offset payment, and the absence of information about the costs of care, the ability of insurers to negotiate lower costs and the role of Medicaid in affecting overall costs forced both sides into guessing too often.

Lawmakers cannot continue to whittle away at Dirigo and expect it to grow; they can’t publicly doubt the effectiveness of the program and expect people to be attracted to it. Opponents to Dirigo, encouragingly, changed tactics a few months ago and stopped announcing their intention to kill the program. But the endless fights over what is a straightforward attempt to expand health care coverage by increasing efficiency deserves support so that potential clients know the program will be around long enough for them to benefit from it.

A commission on long-term funding suggests at least that there will be a long term. Whether that means a robust plan that responds to changing demands in the health care market, or an inconsequential one that is always under fire from the Legislature, could be determined by the ingenuity of the commission.

Either that, or supporters and opponents go back to all-out arguing.