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AUGUSTA — The
Dirigo Health Agency has spent $7.2 million to
date, even though the state’s subsidized
insurance program has been covering subscribers
for only a little more than two months.
That figure has
prompted Republican lawmakers to question
whether agency promotion and overhead costs are
out of line.
The biggest
chunk of money, $3.2 million, went to the
Department of Health and Human Services in the
current fiscal year to fund 13 permanent
positions and five temporary ones assigned to
work on the program.
The agency
itself now has filled 13 temporary positions,
with a separate office in downtown Augusta and a
request to make 18 positions permanent in the
2006-07 budget.
Another eight
positions in the Governor’s Office of Health
Policy and Finance also support the agency but
work on other health-planning projects,
including research and development of statewide
health policies.
Anthem agents,
paid by the insurance company, sell the
insurance, issue cards and process initial
claims through a joint venture with the state.
They sold the
insurance, known as DirigoChoice, to 2,666
people through February, with another 1,000 or
so expected to enroll in March. The goal of the
program is to insure Maine’s 130,000 uninsured
by 2009.
About $877,000
has been spent to market the insurance and to
generally inform Mainers about state health
planning toward the goals of reducing costs and
improving quality. The money, including $557,000
in grants, paid for radio, TV and newspaper
advertising, public relations consulting and Web
site and newsletter design.
The rest of the
money came out of the agency’s operating budget,
being funded by $53 million in start-up funds
for Dirigo that initially came to the state from
the federal government as supplemental Medicaid
dollars.
“It just looks
like growing government to me,” said Rep.
Darlene Curley (R-Scarborough), who sits on the
Appropriations Committee. That committee is
reviewing Governor John E. Baldacci’s $5.7
billion biennial budget to make recommendations
to the full Legislature.
Curley said
she’s worried about the growing role of the
Office of Health Policy and Finance and wonders
why it couldn’t be folded into DHHS. She also
questions why the state needed to do all its own
original research on health issues and costs.
“Do we have to
do everything ourselves?” she asked.
Sen. Richard
Nass (R-York
County), the Republican’s Senate representative on the Appropriations
Committee, described Dirigo as “faltering” in
terms of the numbers it is attracting. He
questioned whether those who were signing up
were truly uninsured or simply switching from
another plan.
Defending Dirigo
While the Dirigo
health plan was passed with GOP support in 2003,
some Republicans are distancing themselves from
it, saying the plan hasn’t delivered on promises
of affordable health insurance for small
businesses. Baldacci, however, touts it whenever
he can, and calls it one of the crowning
accomplishments of his first term in office.
Dirigo Health
Agency Director Karynlee Harrington defended the
program and chastised Republican legislators for
their seeming barrage of criticism about it last
week.
“Why don’t we
have the numbers?” Harrington asked the
committee, meaning numbers of enrollees. “It’s
so challenging when it [DirigoChoice] is
constantly criticized.”
While admitting
the plan isn’t perfect, she said it’s needed to
address the problem of uninsured in Maine.
“I have a lot of
passion for this plan,” she said. “Right now we
need to do something.”
Harrington also
rebutted claims by some that the process to get
enrolled is confusing.
“It’s not
cumbersome,” she said. “There are two options
that people can choose from,” and the rest is
done behind the scenes by DHHS, which calculates
whether people are eligible for the state to
subsidize part of their premium.
Under the
program, employers pick up 60 percent of the
cost of the monthly premium for employees,
starting in the $300-plus range for individuals.
Family policies can run from $900-plus to more
than $1,000 per month, but the employer only is
responsible for the employer’s share. The
employee’s share is subsidized by the state if
individuals fall into certain income categories,
starting with workers making less than 300
percent of the federal poverty level.
Sen. John Martin
(D-Aroostook) agreed the application process is
simple enough. He told his fellow Appropriations
Committee members that he is an authorized
Anthem agent and sells DirigoChoice.
Enrollment numbers
The Baldacci
administration had hoped to have the
DirigoChoice subsidized insurance program up and
running by last summer, but it started covering
Mainers in January.
Trish Riley,
director of the Office of Health Policy and
Finance, said the first quarter has exceeded
expectations, although the goals have been a
moving target.
To meet the
original first-year goal of signing up 31,000
people, 27,254 more will have to come on board
in 2005.
That enrollment
expectation has been lowered, Riley said,
because the state has put on hold its proposed
expansion of Medicaid (called MaineCare in
Maine) to adults without dependent children.
That expansion, and one that is going forward
for parents at 200 percent of the federal
poverty level, was expected to add to the ranks
of DirigoChoice.
The idea was
that some of these new Medicaid enrollees, who
are part of the state’s working poor, would be
signed up for insurance by their employers, who
would pay 60 percent of the premium. The state,
through Medicaid, would pick up the employee’s
share of costs, triggering a 2-to-1 federal
match that would help keep the Dirigo program
going.
Expectations now
are being lowered to 23,000 enrollees in 2005.
The next hurdle
the program faces is coming up with a plan to
tax insurance companies and self-insured groups,
who will be asked to contribute up to 4 percent
of their premium revenue to the Dirigo Health
Agency’s operating budget.
Those savings
are expected to come from cost controls put on
hospitals and a reduction in bad debt and
charity care that comes as a result of having
more people in the state insured. How that tax
will be applied has to be approved by the
Legislature, which is expected to review a bill
later this session. |
