AUGUSTA (AP) – After an intense month of negotiations on a difficult and complex issue, Maine legislators are on the verge of voting on what its supporters call the nation’s most far-reaching universal health care bill.

“This is the only state in the country that has a clear plan, funded to provide universal health care in five years,” said state Sen. Michael Brennan, who chaired a committee that handled talks among disparate and often doubting interests.

Ultimately, hospitals, insurers, doctors, businesses and patient advocates all signed on to a reworked version of a bill first introduced in May by Gov. John Baldacci.

With unanimous committee support and the governor’s endorsement of what he sees as a vastly improved bill, final passage by the House and Senate of the Dirigo Health plan appeared likely, if not assured, this week.

“In terms of doing something new that gets us close to universal health care, Maine is definitely a leader,” said Donna Folkemer of the National Conference of State Legislatures.

Dirigo, the state’s motto, is Latin for “I lead,” and elected officials regularly refer to the phrase in boasting of the state’s effort to drive down prescription drug costs

Under the Dirigo bill, set to take effect in July 2004, all 180,000 Mainers who cannot afford health insurance would have access to coverage within five years of that date. The bill would create a quasi-public state agency under the Dirigo banner to secure coverage through private insurers for those who can’t afford it.

“In the absence of the feds not moving in the right direction, it falls to the states to pick up the pieces,” said Arthur Levin, director of the New York-based Center for Medical Consumers.

Only about a half dozen other states are considering bills that take substantive steps toward universal coverage, said Richard Cauchi, a health policy expert for the NCSL.

Under Maine’s bill, self-employed workers and owners of small businesses would be able to provide employee coverage, including prescription drug benefits, through Dirigo. Employees would contribute premiums based on ability to pay.

The program expands eligibility under MaineCare, formerly the state’s Medicaid program, so more people are covered. Unemployed people and those whose companies don’t offer coverage could purchase policies.

A single mother who earns $37,000 a year, for example, could get coverage through her employer, who would pay 60 percent of the premium cost – about $297. The woman would pay the remaining 40 percent, or $198, under a scenario laid out by supporters.

The legislation also includes steps to hold down the runaway costs of medical and health treatment, which is what makes insurance so prohibitively costly in the first place. Among them are voluntary caps for providers, hospitals and insurers on operating margins, and a hold-down on non-hospital outpatient procedures.

“It means,” said Brennan, D-Portland, “that everybody in the world won’t be getting an MRI.”

While Brennan maintains the bill could be one of the most significant pieces of legislation Maine will have passed in 25 years, some doubts linger even among those who have endorsed it.

Maine Hospital Association President Steve Michaud said only time will tell if the legislation will lead to true universal health care.

“There’s real cost containment and real reforms,” added Michaud, “but it would be a disservice to say premiums will go down and access to health care will be free or cheap.”

Maine’s largest health insurer, Anthem Blue Cross Blue Shield, sees the bill as “a vehicle” to get to insurance access for all Mainers, a goal the insurer shares, said company’s State House representative Katie Fullam Harris.

The funding elements of the bill remain a sticking point for some businesses. Dirigo would be financed through a patchwork of sources, including federal funds and $80 million the state would recoup by eliminating bad debt and charity costs run up by non-insureds.

Dirigo would collect that money through “assessments” paid by insurers, who would no longer have to pass their charity and bad-debt losses to ratepayers.

“Theoretically, premium payers will never see an increase in their premiums and should see a reduction” thanks to universal care, said Anthem’s Harris.

But some small business groups aren’t so sure, saying the bill includes no guarantee that the premiums they pay for small group policies will go down.

Rather than reducing everyone’s health care costs, the Dirigo bill “only ensures that the vast majority of businesses will see no cost reductions and will likely be paying more,” said Tim Walton of the Associated Builders and Constructors.

AP-ES-06-11-03 1838EDT

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