The Dirigo Health Care Reform Act: A Work in Progress Maines Reform Strategy for Improving Costs, Qu

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The Dirigo Health Care Reform Act A Work in
ProgressMaines Reform Strategy for Improving
Costs, Quality Access in Health Care
Institute for Health Policy

• Elizabeth Kilbreth, PhD
• Muskie School of Public Service
• University of Southern Maine
• November, 2007

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Dirigo Access Initiative

• Medicaid eligibility expansions
• Publicly-sponsored, subsidized insurance plan
  targeted to small business, self-employed, and
  some uninsured individuals The DirigoChoice
  Plan
• Various cost-containment strategies

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Maine Dirigo Choice and Healthy NYComparison of
Program Eligibility
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How the DirigoChoice discounts work

• Employer / Self Employed pays 60 of employee
  premium
• Employee / Self Employed discount based on 40
  share of employee premium and 100 coverage of
  dependents.
• Individual discount based on 100 of premium

• 
  

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Maine DirigoChoice and Healthy NYComparison of
Program Administration
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DirigoChoice Member Distribution, August 2007
Total enrollment 15,113
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DirigoChoice Performance

• The program has a 94 persistency rate (94 of
  members eligible to renew chose to do so).
• Approximately 63 of DirigoChoice members were
  either uninsured or underinsured prior to
  enrolling.
• Approximately 40 of DirigoChoice members were
  previously uninsured.
• Approximately 42 of Small Employers enrolled
  were previously uninsured.
• The average household income for DirigoChoice
  (discount eligible) members is 11,814.17

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Comparison of Experience
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Theory Dirigo reform savings fuel future growth
Dirigo Reforms
for DirigoChoice (Savings Offset Payment)
Premiums
Health Service Costs
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Savings Offset Payment

• Assessment on health insurance premiums and
  ASO claims volume 4 maximum
• Amount assessed must be offset by
  demonstrated system savings
• Assessment levied by Bureau of Insurance
• First Year Assessment 2.3

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Counter proposal from critics

• Deregulate the insurance market
• High Risk Pool
• Reinsurance program for all carriers in
  individual insurance market

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Lessons

• Everyone wants universal access no one wants to
  pay
• Biggest challenge is probably rate of cost
  increase for health care
• Cannot sustain access expansions without relief
  to payers employers and taxpayers on their
  health benefit costs