The governor’s special commission charged with recommending changes to the state’s Dirigo Health subsidized insurance program flirted with adopting a resolution making universal coverage its goal, but backed off for now, saying more study is needed.
At the commission’s second meeting last week, the issue came up when some members said they wanted to know how many people the plan was supposed to cover before they could recommend a funding mechanism.
“It’s hard to know which tax to pick and how much to charge without knowing how many people we intend to cover,” said David Brenerman of UnumProvident. He later spoke against adopting universal health coverage as a goal, at least for the time being.
“Saying today that we’re for universal coverage without knowing what that means… doesn’t’ get us anything but headlines in tomorrow’s paper,” he said.
Kevin Gildart of Bath Iron Works said the decision is a critical one.
“If we decide this is universal care, the answers get easier. If we just try to nibble around the edges of this,” he said, another commission will be sitting in Augusta in five years trying to deal with the problems of the uninsured.
Joe Ditre of Consumers for Affordable Health called for adoption of a motion on universal health, saying the initial charge of the group was to look at funding subsidized health insurance for the uninsured, but “we need to be thinking much more broadly.”
Ultimately, the motion, which was initiated by Dr. Peter Toussaint of New Canada, was withdrawn, but could be revisited before the commission’s report is due in mid-December.
The executive order that created the blue ribbon commission, in fact, talks about the state’s efforts to achieve universal health-care coverage as part of the reforms passed under the Dirigo Health act, but doesn’t say how to get there. It could involve a combination of health-care plans to assure there are no uninsured in the state.
The discussion underscored the enormity of the task facing the commission, made up of 20 people representing hospitals, insurance companies, employers, labor unions, doctors and consumer advocates. The group is supposed to recommend changes to DirigoChoice – the state’s subsidized health plan offered by Anthem – which currently covers around 10,700, the majority of whom have their premiums subsidized by the state.
The program has become an election-year issue because the Baldacci administration over-promised results in the program – saying 31,000 would be insured in the first year. The way the program is funded through an assessment on premiums paid by those who buy regular health insurance is another political hot button.
While the focus has been on the inherit cost-shifting in that method of subsidy, it also doesn’t raise enough money – just under $44 million this year -to grow the program much beyond where it is now. Yet the number of uninsured in the state is estimated at between 130,00 and 140,000.
The commission’s main charge is finding a different way to fund the insurance, and the Muskie School of Public Service gave members an overview of how other states are doing it.
Their research found that “there is no magic bullet funding source for state coverage initiatives,” and most rely on a combination of taxes and fees including: sin taxes on cigarettes and alcohol; assessments on medical providers and private insurance premiums; tapping into state uncompensated care funds; and, trying to tap into federal Medicaid money.
The Muskie School also found that DirigoChoice’s slow start out of the gate was not unusual when compared to other programs in New York State, Washington and New Mexico. In New York, for example, first-year enrollment was only 6,000 out of more than 1 million uninsured.
“Much of the media commentary and policy discussions about the DirigoChoice program in Maine has been premised on the assumption that the program would enroll 31,000 in its first year. Held to this standard, the program has been deemed by some as a failure. An analysis of the experience of other states…makes clear this standard is entirely unrealistic,” researchers said.
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