DirigoChoice debate focus of Bangor forum

BANGOR – For anyone still unclear about the controversy surrounding DirigoChoice, the state’s subsidized health insurance program, a Thursday morning forum in Bangor offered an opportunity to become better informed.

At a business breakfast co-sponsored by Eastern Maine Healthcare Systems and the Bangor Region Chamber of Commerce, an eight-member panel of Dirigo promoters and critics weighed in on the thorny issue before an audience of about 130 of the area’s business leaders.

Michelle Hood, recently named CEO at EMHS, spoke briefly, saying she viewed the presentation as an opportunity to inform herself about DirigoChoice and how it might be improved. Hood said finding a workable solution to the health care crisis is essential to the future of area businesses. “The Dirigo plan is in its adolescence,” she told the audience. “We want to make it work.”

Trish Riley, director of the Governor’s Office of Health Policy and Finance, presented a 20-minute overview of the insurance program, which is part of a larger set of initiatives aimed at holding down the cost of health care while improving quality and access to care. Riley noted that the program, recently was the target of much political “sturm und drang” in the Legislature, was originally signed into law with the unanimous support of the Insurance and Financial Affairs Committee and a two-thirds majority in both the House and Senate. “We need to get back to the table and talk about how to keep it going,” she said.

Riley said a recently-appointed Blue Ribbon Commission soon will begin trying to resolve some of the more problematic issues, such as the controversial Savings Offset Payment the program relies on to provide premium subsidies to lower-income enrollees. The SOP is intended to reflect savings achieved in the health care system as a result of the various Dirigo initiatives. The state says insurers should pay the money back to the program to be used to provide affordable coverage to uninsured and underinsured Mainers.

Savings achieved in 2004, Dirigo’s first year in operation, were determined by the Maine insurance commissioner to be $43.7 million, but insurers, along with the Maine State Chamber of Commerce, have filed a lawsuit against the state over the method of determining and collecting the payment.

Riley also outlined other Dirigo initiatives, including efforts to standardize the medical treatment of common health conditions, tighter regulation of hospital spending on big-ticket expansions or equipment, and the development of a statewide electronic medical records system.

Dan Coffey, executive vice president at EMHS, spoke after Riley. Hospitals, he said have been working toward cost containment and quality improvement since before Dirigo came on line in 2003. Since the initiatives took effect, he said, hospitals have been doing their best to support and comply with them. Coffey said hospitals are perceived as the most visible “targets” for reform and as “lightning rods” for criticism, when, in fact, they provide a critical safety net for all Mainers in need of care.

DirigoChoice, Coffey said, lacks a financially feasible business plan and should not be allowed to become a self-insured group, as was proposed unsuccessfully in the recent Legislative session. Noting that MaineCare, the state’s Medicaid program, is notoriously cash-strapped and owes hospitals millions of dollars in back payments, Coffey questioned whether a self-insured DirigoChoice would be more responsibly managed.

Coffey said the SOP insurers are being asked to pay is simply a tax and constitutes “double dipping” because insurers already reflect lower costs in the premiums they collect from their customers. Finally, Coffey faulted the state for expanding its Medicaid program by 45 percent over the last five years, making Maine the state with the highest per capita Medicaid enrollment.

Other speakers included Christine Ossenfort of the Maine State Chamber of Commerce; Sen. Joe Perry, D-Bangor; Sen. Richard Rosen, R-Bucksport; an insurance broker; and two business owners, one who insures with DirigoChoice and one who uses a commercial insurance company.

After the session, Hood said she felt encouraged that despite the lack of agreement on some issues, “there is a general willingness to try and find solutions” to DirigoChoice’s problems. She welcomed the creation of the study commission and said input from EMHS should be included as meaningful responses are sought to the state’s health care crisis.

Riley said DirigoChoice cannot be improved when it’s the subject of election-year posturing and industry self-interest. Designed to offer choice to consumers and to stimulate competition in Maine’s insurance market, the plan remains a work in progress, she said. As long as stakeholders “stay in their corners and point fingers and blame each other” for the program’s shortcomings, Riley said, DirigoChoice will remain a political football instead of the important health care alternative it was intended to be.

She said she remains hopeful that all parties will “get back around the table in good faith.”