November 23, 2024
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Savings estimate for Dirigo lowered

AUGUSTA – It looks as though financing for Maine’s program to promote affordable health care will remain limited, perhaps just enough to keep it steady – and stuck.

Maine’s insurance superintendent has found that health care system savings attributable to Dirigo Health were $48.7 million last year, only about one third of what had been claimed by the Dirigo agency board.

The director of Gov. John Baldacci’s Office of Health Policy and Finance, Trish Riley, said the finding by Insurance Superintendent Mila Kofman came in 50 percent higher than last year.

“I believe [it’s] the highest savings we’ve had to date,” Riley said.

Still, Riley said, the most likely result of the ruling would be that “it would keep the program pretty flat.”

Citing “extraordinary circumstances” while referring to the statutory deadline for a decision, Kofman issued the first part of what she said would be a two-part decision late Tuesday night.

Breaking out individual savings categories in the Dirigo board filing and listing what she found to be reasonably supported by evidence in the bureau’s regulatory proceeding, Kofman lowered suggested hospital savings initiatives from $119.4 million to $40 million.

Similarly, credit for uninsured and underinsured savings initiatives was dropped from $23.6 million to $6.1 million. Kofman also scrapped $4 million as double-counting.

From a proposed total of $149.6 million, that put the superintendent’s total at $48.7 million.

Kofman said she would issue a “full statement of findings of fact made by me as the basis for my decision” no later than Sept. 30.

“We won’t know all the details until the end of September,” Riley said.

The next step would be for the Dirigo Health board to translate the superintendent’s determination of savings into an annual assessment on health insurers known as the savings offset payment.

Baldacci issued a statement maintaining his support for a program he has championed.

“Every state in the nation is struggling to contain health care spending that is rising at a rate more than double that of inflation. Maine took a bold step five years ago to address rising costs, and we are achieving real and cumulative savings in the health care system through Dirigo.

“Meanwhile, Maine is succeeding in offering quality health coverage for more residents. While DirigoChoice is just part of the solution, it’s an important part, and it has literally saved lives. More than 620 small businesses have DirigoChoice coverage, and Dirigo has been responsible for 29,000 Mainers having access to affordable insurance since its inception, and has increased competition in the individual market.”

In July, the board of Maine’s Dirigo program said the state-backed health insurance system had provided nearly $150 million in health care savings through avoided costs in the last year and voted to forward that figure to the Insurance Bureau for a review and hearing.

At the time, Maine health insurers called the Dirigo Health board estimate “extremely overstated” and “not credible.”

The Maine Association of Health Plans, a nonprofit trade organization, said that for the fourth year in a row the Dirigo Health Agency board had overstated savings from health plan hospital and physician contract negotiations.

In embracing a $149.6 million figure, the Dirigo board trimmed an earlier savings offset estimate by staff and consultants that added up to $190 million.

Savings offset payments, which target insurers, have been a critical funding source for Dirigo Health, Maine’s five-year-old effort to expand health coverage. But the assessments have triggered regulatory battles and court fights.

Many Dirigo supporters in and outside the Legislature have been hoping to avoid reliance on the unpopular assessments through new taxes on soda, beer, wine and surcharges on paid insurance claims.

Those new taxes, however, are facing a strong people’s veto referendum challenge.

Early campaign finance reports showed substantial business backing for the repeal drive including a $100,000 donation from the Maine Beer and Wine Wholesalers.

The Maine Restaurant Association and Maine Beverage Association each gave $25,000; Maine Soft Drink Association, $15,000; Maine Automobile Dealers Association, $10,000; Maine Innkeepers Association, $6,000.

Repeal opponents brought together as Health Coverage for Maine initially reported receiving $10,000 from the Maine State Employees Association and $100,000 from S. Donald Sussman of Greenwich, Conn., chairman and CEO of Paloma Partners management company.

On Wednesday, Maine State Chamber of Commerce analyst Kristine Ossenfort put off detailed comment on Kofman’s decision until the findings of fact are issued.

But in a statement Ossenfort said, “The superintendent’s decision makes it clear, however, that the Dirigo Health program will continue to exist and those people who are currently covered by the program will continue to be covered, even if the people’s veto prevails.”


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