Another Bureau of Insurance ruling on the state-subsidized health plan, another year of widely divergent views of how much the program saved the health-care system. But Dirigo Health has gone through this process enough, and endured a tough though favorable court ruling, so that the Baldacci administration and bureau should be much closer to agreeing on a savings figure. Trust in the program is at stake.

The annual Dirigo debate is over determining the savings offset payment. That’s the amount of savings in Maine’s overall health care system because of Dirigo’s effect on holding down costs and reducing the need for charity care. The Dirigo board recently said that savings was $78.1 million. The acting superintendent of insurance said it was really $32.8 million.

That disparity follows last year’s, where the board concluded the savings was $41.5 million and the superintendent allowed $34.3 million of that. The year before that, the board estimated savings at $110.6 million and the superintendent called it $43.7 million.

Clearly, the board and the superintendent – plus hospitals and insurers – have a deep disagreement over how to measure the voluntary spending caps and limits on capital expenditures that go into the savings. The worst reason for this occurring is that the superintendent is merely finding a more palatable number for the insurers that must pass this savings along to Dirigo, which it then uses to provide coverage. A second potential problem, despite honest attempts to avoid it, was what Justice Donald Alexander wrote in a dissenting opinion in a case that upheld the state’s right to collect this money.

According to Justice Alexander, “The fact that the Dirigo Health Board of Directors and the Superintendent of Insurance could arrive at such dramatically different figures for ‘aggregate measurable cost savings’ demonstrates the significant ambiguity of the term and the highly subjective, judgmental analysis it invites the Board and the Superintendent to use in determining the savings offset charge.”

The board has worked hard to remove that ambiguity; but it’s not clear that this is understood by both sides. Similarly, issues that had been settled in previous rounds seem to arise again this year – the question of hospital profit margins in certain circumstances and some interim payments affected the outcome this year in ways they might not have previously.

When the two agencies consistently come up with such very different numbers for what is supposed to be an objectively derived figure, the public deserves reassurance that the savings is being figured in a fair and open manner.

This is an issue for legislators to re-visit (they’ve worked on this before) – to review the past decisions, ensure the bureau is following established legislative instruction, hold hearings to understand the discrepancies, and develop further language to reduce the gap in savings expectations. The ongoing difference in savings payments makes the program look shaky, and that’s not healthy for Dirigo or the people covered by it.