What's happening with Dirigo Health?

[Shorebound]

Anyone have any insights on the governor's plans for Dirigo Health this year? There was a recent news story in the Blethen papers that he plans to offer some changes, but the details were awfully vague. I've heard rumors that he's thinking about proposing the creation of a high-risk pool -- the original Dirigo legislation contains provisions for it IIRC -- and changing the funding formula.

[Name removed]

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[mile53]

3. You stink

like you are unwashed to me!

[luckyleftyme2]

8. nice

must be that este warren residue. good to see the responses are 75% republicans.

[Maine-ah]

2. .

here is the most current ifo I have about it

http://www.wcsh6.com/news/article.aspx?storyid=56183 Anthem is raping us imho, and it looks like they're trying to get rid of 'em.

[high density]

7. This is the best news I've heard about Dirigo in a long time

I thought it seemed pretty obvious from the start that having a private company administer it was just going to be a waste of money.

[MaineDem]

4. Here's a statement from Rep Jill Conover

She's sponsoring a bill to make Dirigo self-funding.

++++++
Thank you for your recent support. Yesterday when I presented my testimony for LD 431, I felt that all of you were there with me in spirit:) I am writing today to once again ask for your assistance to help ensure this priority bill moves through the process successfully, all the way through enactment.

It would be very helpful if you would again share this Action Alert with your members, so that we can show grassroots statewide support for this bill.

My presenting testimony is copy/pasted below for your reference. It would be helpful if folks were able to 1) call and leave a message for IFS Committee members, asking them to support LD 431, "An Act to Enable Dirigo Health to Self-Administer". The IFS Committee will be working this bill on Friday -- so if you can call today or tomorrow they will consider your input prior to the worksession. 2) Also if they have not already done so, folks could leave a message for their State Senator and Rep. at the same time.

* You can call toll free and leave a message for any State Representative by calling 1-800-423-2900.

* You can call toll free and leave a message for any State Senator by calling 1-800-423-6900.


IFS Members are:

Senator Nancy B. Sullivan (D-York), Chair <http://www.state.me.us/legis/senate/senators/bios/bio04s.htm>

Senator Peter B. Bowman (D-York) <http://www.state.me.us/legis/senate/senators/bios/bio01s.htm>

Senator Lois A. Snowe-Mello (R-Androscoggin) <http://www.state.me.us/legis/senate/senators/bios/bio15s.htm>

Representative John R. Brautigam (D-Falmouth), Chair <http://janus.state.me.us/house/hsebios/braujr.htm>

Representative Marilyn E. Canavan (D-Waterville) <http://janus.state.me.us/house/hsebios/caname.htm>

Representative Sharon Anglin Treat (D-Farmingdale) <http://janus.state.me.us/house/hsebios/treasa.htm>

Representative Charles R. Priest (D-Brunswick) <http://janus.state.me.us/house/hsebios/priecr.htm>

Representative Jill M. Conover (D-Oakland) <http://janus.state.me.us/house/hsebios/conojm.htm>

Representative Patsy Garside Crockett (D-Augusta) <http://janus.state.me.us/house/hsebios/crocpg.htm>

Representative Wesley E. Richardson (R-Warren)* <http://janus.state.me.us/house/hsebios/richwe.htm>

Representative Michael A. Vaughan (R-Durham) <http://janus.state.me.us/house/hsebios/vaugma.htm>

Representative Jonathan B. McKane (R-Newcastle) <http://janus.state.me.us/house/hsebios/mckajb.htm>

Representative David G. Savage (R-Falmouth) <http://janus.state.me.us/house/hsebios/savadg.htm>



Sincere thanks for all you are doing!

- Jill





March 27, 2007

Testimony of State Rep. Jill Conover

Before the Committee on Insurance and Financial Services

In Support of LD 431, “An Act to Enable the Dirigo Health Program to Self-Administer”

Good afternoon Senator Sullivan, Representative Brautigam and Members of the Committee. My name is Jill Conover, and I serve as State Representative for District 78 (part of Oakland, and Sidney). I am before you today as the sponsor of LD 431, “An Act to Enable the Dirigo Health Program to Self-Administer.” Thank you to the co-sponsors of this bill, and to all who have taken the time to come to testify today, representing many more who are unable to take time off from work responsiblities to do so.

To begin, I’d like to quote from a recent news release: “Maine has led the way with the Dirigo Health initiative and its earlier steps to expand Medicaid. The success of these approaches is demonstrated by Maine’s lower than average uninsured rate.” - Erin Hoeflinger, President, Anthem Blue Cross and Blue Shield

I agree with this statement made by Anthem President Erin Hoeflinger in the company’s press release unveiling their national plan to cover more uninsured, based, as it describes, in large part on success here in Maine. Maine is leading with this nationally acclaimed program. To address their own health care crisis, we today are seeing other states choosing to model parts of their health reform efforts on Dirigo. Here in Maine we are off to a good start with this important, young program.

Dirigo is delivering for Maine, is leading the market as the best product out there, and is our best chance to get all of our people covered. The program, however, needs appropriate tools such as the option to self-administer, as other entities have, which would expand coverage to more of Maine’s uninsured and underinsured small businesses and working families. LD 431 would enable Dirigo to expand by taking profits that would otherwise go to Anthem and investing them back into the program to help cover more people. This is the right thing to do because it helps our people keep themselves healthier. It is also cost-effective, as access to preventive care and chronic disease management reduces costly emergency room visits and hospitalizations. Businesses benefit from a healthier and more productive workforce. And healthy families and businesses make a healthier Maine economy.

To avoid any confusion as to what this bill would/would not do in the context of the over 100 bills this committee will still be hearing, I’d like to offer some clarity: This is not a single-payer bill, it is not the bill that would create a Maine-based nonprofit health insurance company, and it is not an alternative funding bill. We will hear and give thoughtful consideration to those and other bills later this session.

LD 431, the bill before us today, would simply provide the Board of the Dirigo Health Agency with the option of becoming self-administered if DHA determined it would be in the best interest of the program and those it serves to do so. This step, which was a recommendation of the diverse, 20-member Blue Ribbon Commission on Dirigo Health, would allow the Board to determine the benefit design, marketing and administration of the plan. Most entities covering more than 5,000 enrollees choose to self-administer, because of the cost-savings. Familiar examples of those who have done so include the Maine State Employees Association, hospitals and many large employers in the state. Now that DirigoChoice covers over 13,000 enrollees, self-administering is the next logical step.

· LD 431 retains the nature of Dirigo Health as a public-private partnership. The Dirigo Health Agency Board (DHA), like other entities that self-administer, would likely use a private third-party administrator (TPA) to handle the processing and payment of claims, as well as contract with a private carrier for stop-loss insurance (to cover extraordinary claims).

· Self-administering would reduce the cost of administrative overhead and profits associated with a fully insured plan, in this case, Anthem. <1> <http://us.f364.mail.yahoo.com/ym/Compose?box=Sent&Mid=4646_11695836_109754_1186_36213_0_9604_80725_3396948394&inc=&Search=&YY=39424&y5beta=yes&y5beta=yes&order=down&sort=date&pos=1&view=a&head=b#_ftn1> While the program would still contract a TPA to process claims, TPAs have significantly lower overhead and expenses than a fully insured plan.

· We appreciate Anthem’s role in helping this program get started, and we fully understand and appreciate that the driver for a private corporation is profits, but that is not our mission. Our goal and responsibility is to ensure that every penny possible is invested in providing more people access to the coverage and care they need.

Dirigo is the only plan in our state that offers accessible, truly guaranteed, comprehensive health care coverage on a sliding scale basis, that is there when people need it. We should support the next evolution of Dirigo, which is our best opportunity for achieving quality, affordable health care for all Mainers.

Dirigo provides comprehensive coverage and encourages prevention, which we know is a good investment for today and tomorrow, saving both lives and dollars. Dirigo offers our working families a meaningful choice, as opposed to some of the bad choices on the market with sky-high deductibles, or exclusionary plans that serve only to restrict access and utilization of care, and in the long-run drive up medical debt. Our families want health security that protects both their health and their assets. They are tired of paying more for less or nothing. Dirigo is unique in combining guaranteed issue -- with no pre-existing conditions and no medical exclusions or waiting periods -- with guaranteed renewal, and offering this on an affordable, sliding scale basis. No other plan out there combines these elements in this way.

LD 431 ensures effective regulation, oversight and administration of a Dirigo self-administered program.

* If DHA were to choose the option to self-administer, as provided in LD 431 it would likely make Dirigo the most regulated self-administered plan in the state of Maine, subject to regulation enforced by the government that most other self-administered plans in our state are not subject to. LD 431 would require the self-administered plan to meet the same requirements of the Maine Insurance Code that would be required by state law if health benefits coverage were provided by a fully insured health insurance carrier for community rating, guaranteed issuance, guaranteed renewal, continuity of coverage and mandated benefits.

* The bill also requires that the self-administered plan extend the same benefits, rights and protections of the Maine Revised Statutes, Title 24-A, chapter 56-A and Bureau of Insurance Rule 850, including a right to sue the Dirigo Health Self-Administered Plan. The bill also waives the States defense of immunity under the Maine Tort Claims Act.

* Additionally, in terms of oversight, the Dirigo Board of Directors, which provides supervision over Dirigo Health, would be increased in size and would become the Dirigo Board of Trustees. Trustees would remain subject to legislative confirmation, and have added fiduciary responsibilities related to self-administration. The bill would make Board members subject to personal liability provisions of Uniform Trust Code for trustees. A minimum number of Trustees with financial expertise and other areas of expertise would be required, and the bill provides expectations around oversight of administrative processes that would ensure an effective and accountable program (e.g., the budget would be subject to legislative approval, the bill would require outside, independent actuarial analysis to determine reserves and the rate structure which would be subject to the review of the Superintendent and approval of the Board, financial statements would of course be audited, and regulatory compliance ensured.)

* The added provisions in LD 431 are above and beyond existing oversight and accountability mechanisms Dirigo is already subject to which would be retained. Dirigo would continue to report to their legislative Committee of Jurisdiction, the Committee on Insurance and Financial Services, on the program and budget.

Providing Dirigo with the option to self-administer is the next logical, reasonable step that would enable “Dirigo 2.0” to expand access to quality, affordable healthcare to more Maine people, to put people over profits, and provide true health security to our families.

Please vote “Ought to Pass” on LD 431.

P.S. Staff members from the Governor’s Office of Health Policy and Finance are here to answer any technical questions.


<1> <http://us.f364.mail.yahoo.com/ym/Compose?box=Sent&Mid=4646_11695836_109754_1186_36213_0_9604_80725_3396948394&inc=&Search=&YY=39424&y5beta=yes&y5beta=yes&order=down&sort=date&pos=1&view=a&head=b#_ftnref1> In this case Anthem’s over 15% net underwriting gain ($3.6 million in 2005). Calculation based on Anthem’s third-amendment to their 2005 Rule 945 filing with the Maine Bureau of Insurance. This does not include more recent rate increase that is currently being defended in court.


Representative Jill M. Conover

House District 78 (Part of Oakland and all of Sidney)
P.O. Box 694, Oakland, ME 04963-0694
Cell: [phone]
E-mail: [e-mail]

Website: http://www.maine.gov/legis/housedems/jconover/ <http://www.maine.gov/legis/housedems/jconover/>

[Shorebound]

5. Thanks for the update, folks

Jill Conover's testimony was especially interesting.

My apologies that it took more of Luckless's b.s. aimed at me to bring this to the top of the pile again. He's back on my Ignore list now.

[Name removed]

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[ticapnews]

6. If anyone tries to get in touch with...

Snowe-Mello or McKane, let us know how they respond. Should be good for a laugh :D