Dirigo plan hailed as victory for Maine consumers

AUGUSTA – Gov. John Baldacci unveiled Thursday how much it will cost to enroll in the state’s first-in-the-nation health coverage plan, Dirigo Health-Care Works.

Monthly costs will range from $262 to $846 depending on the number of family members and the choice of deductible. Costs will be lower for people whose income is less than 300 percent of the federal poverty level, which is $37,470 a year for a family of two.

“It’s the ‘Sam’s Club’ of health care. High quality products at lower costs,” said Dirigo architect Trish Riley.

The plan will be comprehensive and will include prescription drug coverage. Once members pay their deductibles, there’ll be no co-payments for preventive care.

A $15 co-payment will be required for a doctor’s visit for nonpreventive care.

Addressing the crisis of unaffordable health care was the top priority in Baldacci’s campaign when he ran for office. Soon after his inauguration, he announced the creation of the Office of Health Policy and Finance, and introduced legislation to create Dirigo, a voluntary program to help those suffering most from high costs: individuals, small businesses and the self-employed.

“This comes nine months after the Legislature, with bi-partisan support, passed the Dirigo Health Plan act, after seven months of analysis by the Dirigo Board,” Baldacci said Thursday. “We are one step closer to meeting our promise to provide a sustainable health-care system in Maine.”

Dirigo is not a standard insurance program, but a plan where medical services are offered for monthly payments, said Riley, director of the office.

“It’s an affordable product. It’s discounted so people can afford to buy. It builds on the current system of employer-based coverage and private insurance,” Riley said.

Baldacci and Riley pledged Thursday the plan will be offered before summer ends. A July 1 start date was originally planned. Initially coverage will be offered to the self-employed and small businesses with 50 or fewer workers. Enrollment for individuals is planned for the fall, but will be limited in the first year to 4,000 people.

The state will now seek bids from private insurance companies to deliver the program, overseen by the Dirigo Board.

Except for $53 million in start-up costs, the new program will not cost state taxpayers money. It will be paid for by federal dollars and monthly payments from employees, workers and individuals, Riley said.

Once members of the plan have paid their annual deductibles, there’ll be no co-payments for preventive care. “Physicals, blood tests, X-rays, mammograms, all that stuff, there’s no out-of-pocket,” said Riley. That’s to encourage people to take care of themselves, she said, adding that the program will even offer $100 cash awards for people who achieve their doctors’ orders, such as quitting smoking or losing weight.

One of the legitimate Dirigo criticisms has been it’s voluntary, which means “you don’t get everybody in (and paying the costs) because there’s always the young immortals,” Riley said. “The governor’s take has always been, ‘We’re not going to talk about mandates unless and until we calm down the health-care cost growth and get an affordable marketplace.”

Health care reform is hard. “It is rocket science,” Riley said. “We have gone back and forth with numbers, designs, we’ve done focus groups with employers and employees. We’ve talked at length with seven different insurance companies, in state and out. I can’t overestimate the amount of work that’s gone into this.”

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