RUMFORD – The new Dirigo Health program will provide insurance coverage for those who don’t have it. The plan also will set up a way to work with small hospitals and other health care providers whenever medical costs are higher than a 3.5 percent increase for services.

“The 3.5 percent is a voluntary increase,” said Adams Thompson, a spokesman from Gov. John Baldacci’s office. “If they can’t meet it, we want to know why and work with them.”

Thompson’s visit Thursday was an effort to educate health care workers and others who are concerned that the new plan may negatively impact their jobs.

At a meeting held last month by area legislators, nearly 50 upset and worried health care workers attended to voice their concerns. One of their main concerns was a cost of services cap. At Thursday’s meeting, only a handful of area residents turned out to learn what the final plan will be.

“A lot of irate hospital employees were worried about their jobs. We took those concerns to the governor,” said Rep. John Patrick, D-Rumford, who along with Sen. Bruce Bryant, D- Oxford, called Thursday’s meeting.

“More stakeholders, such as insurance companies and medical providers, worked on the process for the final plan. It’s a work in process,” he said.

Thompson said the state intends to sign up 31,000 Mainers with the Dirigo plan in the next year. Then, more will be signed up in the next four years. He estimated that about 150,000 Mainers are without health insurance.

Several agencies under the plan will oversee and control it.

The Maine Quality Forum will collect and distribute health care costs and quality. It will be responsible for educating doctors and other health care providers. It will also require mandatory posting of all medical costs. The Commission to Study Maine’s Community Hospitals will look at the roles played by small hospitals and explore ways these services can be improved.

The Dirigo Health Board will be responsible for overseeing the insurance plan’s benefits package and insurance premium costs, said Thompson.

Dick Lovejoy, a member of the Board of Directors for Rumford Hospital, asked if the plan considers how often a hospital is used, particularly when there is a high percentage of older people in an area.

Thompson said the plan caps individual patient costs, not overall costs for a health care facility.

Lynn Baker said medical facilities should set up something other than emergency rooms for some injuries and illnesses.

“Emergency rooms are so expensive. Most doctor’s offices don’t have weekend hours. In fact, if you call a doctor, they say go to the emergency room,” she said.

Thompson said many people who don’t have health insurance wait until they are so ill that they go to an emergency room. With insurance, that may not happen as often. He said the frequent use of emergency rooms is one topic for study under the Study Commission. If emergency rooms are used less for bad debt and charity care, then health insurance premiums wouldn’t be so high.

Many aspects of the newly adopted plan will have to be worked out during the next few years, he said.

The Dirigo Health Board will be set up next fall. Once that is done, Bryant said another informational meeting will be held to update people and to gather comments.

“Maine has been on the forefront, with prescription drugs and now with the Dirigo Health Plan. This program will be a model for other states. But it will take some years to work through,” he said.

eadams@sunjournal.com

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