A month after signing the national health care law, President Barack Obama visited Maine on April 1 to tout the initiative's benefits.
The new law, Obama said, "would lift one of the biggest burdens" for Americans trying to survive amid stagnant wages and rising health care costs.
Obama's visit to Maine was appropriate. During the health care debate, the state's Dirigo Health program was sometimes referred to as an example of what the federal law hoped to achieve.
The national health care law, Obama said, wasn't perfect, but it was a positive start.
Local opponents of the health care law, however, were quick to highlight Dirigo's failures.
They had plenty of examples.
The program had failed to curb state insurance premiums, which were some of the highest in the country. Enrollment in DirigoChoice, the program's public option, is a fraction of what proponents projected and its user pool is tilted toward the state's sickest residents, thereby driving up costs for low-income participants and making the program unattractive for low-risk individuals.
A 2009 story in the New York Times described Maine as "the Charlie Brown of health care," its efforts to bring health care to the uninsured were well-intentioned, but alas, failures.
But proponents of the health care bill argue that the Dirigo program has the state well-positioned to take advantage of the new federal law.
Some of the gubernatorial candidates agree, while others say the state should pursue other options. One said he would seek to repeal the national health care law.
Eliot Cutler, 64, independent
Cutler said he'd replace Dirigo with a new program that would take advantage of the new federal health care law.
That includes developing "accountable care organizations" that allow doctors and hospitals to team up to find new ways to provide medical services, improve accountability of care and lower administrative costs.
Establishing ACOs is allowed in the federal health care law.
Cutler also wants to align economic and program incentives to identify and reward high-quality care.
Cutler said the state directly purchases more than one-third of all Maine health care services. He said he would use that buying power to lower costs for all Mainers.
He said his administration would emphasize and reward preventive care for both providers and patients in a system modeled after companies such as Cianbro and Hannaford.
Cutler also wants to develop an electronic medical records system.
"We have to start planning our health care system around patients and providers and not insurance companies," he said.
John Jenkins, 58, independent
Jenkins said he would emphasize preventive care and healthy lifestyles to lower health care costs.
Jenkins said the new health care bill would help younger people entering the work force manage a "mountain of debt" because it allows them to stay on their parents' insurance until age 26.
However, he dislikes the penalties that can be levied against people and companies that don't offer mandated insurance.
"If they can’t afford the insurance in the first place, a subsequent penalty seems a bit out of line," he said.
He said Dirigo hadn't delivered on promises. He would rather encourage vendor competition through intrastate insurance providers.
Paul LePage, 61, Republican
Saying the Dirigo "experiment has failed, " LePage said he would pursue an alternative program that would allow Maine to join other states to buy health insurance on the free market.
"We need to find an alternative for those insured by Dirigo and then repeal it," he said.
Not only would LePage repeal Dirigo, he'd work to overturn the national health care law, which he said was "unconstitutional."
LePage said that he would like to bring Maine's insurance costs more in line with New Hampshire's by allowing patients to buy insurance in other states, which he said would increase competition and lower premiums.
LePage would also push for tort reform to make sure lawyers "seeking power and wealth" couldn't initiate "junk lawsuits" against doctors accused of wrongdoing. He said tort reform should balance sound medical practice with doctor accountability.
Libby Mitchell, 70, Democrat
Mitchell said rising health care costs had prevented Dirigo from "living up to its potential," but it has given "tens of thousands of Mainer's the ability to see a doctor."
She added that the program positioned Maine to "achieve universal access to affordable health care by transitioning to Health Insurance Exchanges."
She said Maine could also collaborate with other states to enter large insurance pools that spread risk and decrease rates.
Additionally, Mitchell would create a wellness tax credit for businesses that promote employee wellness programs.
Shawn Moody, 51, independent
Moody said one of the keys to lowering health care costs is increasing competition. Like LePage, he supports allowing individuals to buy insurance in other states, such as New Hampshire.
Moody said Dirigo is a failure. He'd eliminate the program after finding an alternative. He favors joining other states to cooperatively buy health insurance and "allowing free-market principles to go to work."
Kevin Scott, 42, independent
Although Scott calls Dirigo a failure, he believes the lessons learned from the program will set the stage for a more successful health care effort.
Scott said he'd like to create incentives for employee wellness programs.
He said his plan to strengthen the state's agriculture industry would also help in preventive care because it would encourage more Mainers to eat healthy food.