Quiz time: Which of the following provisions has been tucked into the most closely watched health-care bill on Capitol Hill thanks to Senator Olympia Snowe of Maine? Is it a) an annual checkup for every Medicare beneficiary, b) a special health-insurance marketplace in every state that would cater to the needs of small businesses or c) new tax credits to help modest-size firms buy coverage for their workers?

Health systems in other countries and pilot projects in the United States have demonstrated that effective primary patient care that is comprehensive and accessible has the potential to improve health outcomes and lower costs. Primary care does this by ensuring that patients receive effective care measures for prevention and for management of chronic illness, by coordinating the use of testing and specialist evaluation and treatment, and by providing a comprehensive array of medical services in one clinic or office. Avoidance of duplicative care, unnecessary hospitalizations, and emergency room visits results in reduced health care costs. However, the necessary infrastructure and human resources to provide comprehensive and effective primary care are generally not adequately reimbursed to practitioners by payers. For this reason, it is difficult for primary care practices to supply services that are recognized as effective.

June 9, 2009 Reported By: Josie Huang Governor John Baldacci plans to sign a bill tomorrow that's aimed at giving the state's DirigoChoice health insurance program much-needed financial stability. To pay for Dirigo, the state charges health insurers a fee each year, which invariably leads to fights over how much the fee should be. Dirigo supporters say the bill to keep the fee fixed from year to year will avoid the expensive legal battles and bad blood. "The Number one thing that it does is it makes the funding source predictable and stable," says David Farmer, spokesman for the governor. Farmer tried to reassure the 9,000 people getting insurance through Dirigo, which is priced on ability to pay, and another 5,500 people who get Medicaid through the use of Dirigo dollars.

The Maine Senate has given final approval to a measure intended to put Maine's Dirigo Health Insurance program on a healthier financial footing.  The House approved the bill Friday, and Gov. John Baldacci, the bill's sponsor, is expected to sign it.

The bill provides an alternative to the Dirigo Health Program's current funding mechanism, a so-called "savings offset" fee assessed on insurers, which is based on how much health care savings the program generates.  Because the amount of savings is difficult to accurately nail down, the system has led to court battles.

Instead of relying on savings estimates, the new system will assess a fixed 2.14 percent fee on paid claims.  The Maine House passed the measure Friday by a vote of 83 to 53, and the Senate followed suit today by a vote to 20 to 15.

Maine health program funding bill OKd

AUGUSTA, Maine (AP) By a vote of 83-53, the Maine House has given its final approval to a bill that would create a new funding source for the state's Dirigo health program.

Representatives on Friday approved legislation to replace the savings offset payment, now assessed at a variable rate of up to 4 percent of paid claims, with a fixed 2.14 percent payment on paid claims paid monthly.

The savings offset payments that have been used to pay for the state-subsidized Dirigo program have been challenged repeatedly by the health insurance industry.

The measure directs Dirigo's board to reach more uninsured and underinsured Mainers through a more affordable product.

It faces a Senate vote before it can be sent to Gov. John Baldacci for his signature.

(© 2009 The Associated Press. All Rights Reserved.

Snowe has said she supports a national reform based on regulating insurance markets to increase competition while ensuring consumer protections. The primary alternative under consideration — a single-payer, government-run plan similar to Medicare — “is no panacea and should be a last resort,” according to a recent statement from Snowe’s office.

Rosemary Gladstone thinks the nation’s employer-based private insurance coverage system has proven a failure. She thinks a single-payer system is a better idea, and that people should be required to have insurance of one sort or another.

She worries that the Dirigo program, in danger of losing its funding, will collapse.

For now, though, she’s just glad to have coverage.

“I love having health insurance,” she said. “It gives me more motivation to take care of myself, and it provides an extra layer of stability.”

"The legislation directs Dirigo’s board of trustees to revamp the program to make it more affordable. The bill also replaces the savings offset payment with a monthly payment from insurance companies that equals 2.14 percent of their total claim payments. It’s estimated that would generate $42 million a year."

"creating a state of universal coverage. ... DirigoChoice insurance plan has opened enrollment for small businesses and self-employed individuals, through a public-private health insurance venture with Anthem Blue Cross and Blue Shield of Maine. More than 1,000 individuals have already enrolled, and coverage is scheduled to take effect on January 1, 2005. In May 2005, the state announced that Dirigo Health will provide coverage for families earning up to 200 percent of the federal poverty level, up from the previous limit of 150 percent. In announcing the news, Governor John Baldacci said that by expanding coverage, the state will save an estimated $10 million in charity care and bad debt for those who previously had no health insurance. For More Information Web site: http://www.dirigohealth.maine.gov/index.htmlContacts: Trish Riley, Executive Director and Adam Thompson, Legislative and Constituent Liaison, Governor's Office of Health Policy and Finance Phone: (207) 624-7442 "

"Governor John Baldacci hopes, however, that under the incoming Obama administration, Maine could get federal Medicaid dollars to match Dirigo premiums paid by employers and individuals, which would help sustain and expand the program. This federal match was originally intended for the program but was rejected by the Centers for Medicare and Medicaid Service (CMS) and is now under appeal."

via http://blog.spn.org/id.3508/detail.asp via http://blog.spn.org/id.3505/detail.asp

This is a good analysis of Dirigo's current (10/07) situation from the perspective of the insurance industry "Anthem has "a different mission, and that's perfectly fine," says Trish Riley, director of the Governor's Office of Health Policy and Finance (GOHPF), which was created by Maine Gov. John Baldacci (D) to develop and oversee Dirigo. "They had financial expectations beyond our budget, and we couldn't meet it," she explains during an interview. The decision to end the contract "was related to that," she says. During the first two years of the program, GOHPF offered experience modification payments (EMPs) to ensure that Anthem made a profit on the program. Riley says that the state legislature "made clear that it didn't like the arrangement. And we couldn't afford to do it again this year.""