Mainers praise, pan insurance plan The good: savings on premiums; the bad: administrative snags

While politicians thrash out the future of the DirigoChoice insurance plan in Augusta this week, Mainers who have signed up for the health care coverage seem, by and large, to be happy with their investment.

As of mid-April, more than 9,700 Maine people had purchased health insurance from Dirigo, including the owners and employees of almost 2,300 small businesses. From Abbott, Baileyville and Castle Hill to Vassalboro, Wallagrass and York Harbor, enrollees come from all corners of the state.

Maine’s largest metropolitan areas boast the highest numbers of enrollees: 548 in Portland-South Portland, 241 in Lewiston-Auburn and 182 in Bangor-Brewer. Biddeford, Brunswick, Kennebunk, Rockland and Scarborough each have more than 100 people covered by DirigoChoice. In 49 Maine municipalities, only one person is enrolled.

A recent request for comments on the Web pages of the Bangor Daily News brought about a dozen responses.

In Bangor, Lois Oster said she had been struggling to pay $550 a month for a plan with “pretty good” benefits when she heard about DirigoChoice. Self-employed as an indexer for textbooks, Oster said she looked into the fledgling plan and liked what she saw. Now she pays $350 a month.

“That $200 a month makes a big difference,” she said. Oster has encountered no administrative problems using her new policy and has nothing but praise for DirigoChoice – and the man behind it.

“This is the first time in my life any political office-holder has done anything that has directly affected me in a positive way; it’s just fabulous,” she said. “I’m so grateful to Governor Baldacci – it wasn’t just promises; he really did it.”

Beatrice Blake from Blue Hill reported that she had been paying $519 a month for a plan with “a huge deductible” that covered essentially none of her family’s health care costs. Now she pays about $250 a month less for coverage that pays 100 percent of preventive care.

“Within [Dirigo’s] supportive atmosphere I signed up for a colonoscopy, long overdue for someone my age, and found I had two cancerous lesions,” she said. “If it had not been for Dirigo, I would not have received the care I needed to find this problem in time. Now it has been a year since my surgery, I am cancer-free and I am very, very grateful.” She added that Mainers should “wake up and see that we’ve got a good thing” with DirigoChoice.

From Penobscot, 36-year-old Christine West called to say she has applied for DirigoChoice in anticipation of being laid off from her job as a greeting card packer. West and her husband currently pay $900 a month to cover themselves and one child, she said. Their plan has a fairly low deductible but is strict about requiring them to use a narrow network of approved providers. The DirigoChoice plan will provide them with better coverage and a broader choice of providers, she said. The base rate for the plan is about $1,000 a month, but with the subsidy they’re eligible for, the cost will come down to a more affordable $400 a month.

Negative comments about DirigoChoice stemmed mostly from frustration with the process of signing up or difficulty resolving problems. A number of responders took aim at Anthem’s marketing and administration of the plan.

“I think it would be great if DirigoChoice were self-insured,” said Martha Siebert, a sailmaker in Brooklin. “The word ‘sabbotage’ is strong, but I don’t think Anthem is fully supportive of the program.”

“The thing that amazes me is that nobody seems to know how good this program is,” wrote Chris Plumer from Islesboro. “Anthem has a vested interest in keeping the good news from the people who would benefit most from this program. … If more people were aware of how Anthem is robbing them of the health care they deserve, there would be more defections from their high-cost, zero-coverage plans.”

Mark Canter, owner of Bluesboy Music in Bar Harbor, said he had to give up his coverage with DirigoChoice after his recent divorce. Currently uninsured, Canter said DirigoChoice is “a very flawed program,” but his criticism was largely about getting the administrative runaround when he encountered billing problems. “Every time I tried to contact Anthem I was treated like the enemy,” he said. Calls to the Dirigo Health Agency also were frustrating, he said. “They should just dissolve the program and distribute the money they’re spending to low-income people, so they can buy insurance themselves,” he said.

The strongest vote against DirgoChoice came from state Rep. Kenneth Lindell, R-Frankfort. A self-described “outspoken legislative critic of Dirigo,” Lindell wrote that he reluctantly enrolled employees at his financial planning business in the DirigoChoice plan – “the only game in town to lower Maine’s exorbitant health insurance premiums.” But with the announcement that DirigoChoice might “dump Anthem” to become a self-insured group, Lindell said he’s concerned that the plan won’t be well-run and may leave enrollees or employers liable in the event of a lawsuit. “I don’t want to risk a plan that isn’t administered by a competent private insurer,” he wrote.

Lindell has switched his employees to a $5,000-deductible Anthem plan and has set up personal health savings accounts that they will contribute to each month. “I’m pleased that by leaving Dirigo, I’m able to provide my employees with better coverage, and more flexible coverage, at more affordable rates,” Lindell said.