Maine is the Charlie Brown of health care. The state's legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon -- solving one problem while worsening another.

...Maine's history is a cautionary tale for national health reform. The state could never figure out how to slow the spiraling increase in medical costs, hobbling its efforts to offer more people insurance coverage. Many on Capitol Hill have criticized national reform legislation for similarly doing little to tame costs.

Labels: ME, States

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New York - FAIL
Massachusetts - FAIL
Maine - FAIL
Tennessee - FAIL

Despite these state-level failures, President Barack Obama and congressional Democrats are pushing forward a slate of similar reforms. Unlike most high-school science fair participants, they seem unaware that the point of doing experiments is to identify what actually works. Instead, they've identified what doesn't -- and decided to do it again.

Labels: MA, ME, NY, OpEd, States, TN

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...Then the state created a "public option" known as DirigoChoice. (Dirigo is the state motto, meaning "I Lead.") This plan would compete with private plans such as Blue Cross. To entice lower income Mainers to enroll, it offered taxpayer-subsidized premiums. The plan's original funding source was $50 million of federal stimulus money the state got in 2003. Over time, the plan was to be "paid for by savings in the health-care system." This is precisely the promise of ObamaCare. Maine saved by squeezing payments to hospitals and physicians.

The program flew off track fast. At its peak in 2006, only about 15,000 people had enrolled in the DirigoChoice program. That number has dropped to below 10,000, according to the state's own reporting. About two-thirds of those who enrolled already had insurance, which they dropped in favor of the public option and its subsidies. Instead of 128,000 uninsured in the program today, the actual number is just 3,400. Despite the giant expansions in Maine's Medicaid program and the new, subsidized public choice option, the number of uninsured in the state today is only slightly lower that in 2004 when the program began.

...This problem was exacerbated because since the early 1990s Maine has required insurers to adhere to community rating and guaranteed issue, which requires that insurers cover anyone who applies, regardless of their health condition and at a uniform premium. These rules—which are in the Obama plan—have relentlessly driven up insurance costs in Maine, especially for healthy people.

The Maine Heritage Policy Center, which has tracked the plan closely, points out that largely because of these insurance rules, a healthy male in Maine who is 30 and single pays a monthly premium of $762 in the individual market; next door in New Hampshire he pays $222 a month. The Granite State doesn't have community rating and guaranteed issue.

...Unlike the federal government, Maine has a balanced budget requirement. So out of fiscal necessity, the state has now capped the enrollment in the program and allowed no new entrants. Now there is a waiting list. DirigoChoice has become yet another expensive, failed experiment in government-run health care, alongside similar fiascoes in Massachusetts and Tennessee.

Labels: Insurance, ME, States

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Labels: ME, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Dirigo Care has cost the state's taxpayers nearly $164 million in the four years since its inception. Although its intended purpose was to insure 128,000 people who had no health coverage, only 4 percent of that total, or just over 5,000 individuals, have been successfully removed from the rolls of the uninsured and into the state program, according to figures from the Maine Heritage Policy Center.

DirigoChoice costs taxpayers $2,977 per enrollee per year just for the premium subsidy, excluding Dirigo Health Agency administrative costs.

As of April 2008, there were 12,637 individuals covered by DirigoChoice, less than 1 percent of the state’s population.

Only 31 percent of DirigoChoice enrollees -- 3,917 -- were previously uninsured for at least 12 months prior to enrollment. That is only 3.2 percent of the state’s uninsured population.

The marginal cost to state taxpayers is $9,603 to subsidize the coverage for one previously uninsured person through DirigoChoice.

Maine’s uninsured rate from 2003 to 2006, the latest year available, is virtually unchanged – 128,000 uninsured in 2003, 115,000 in 2004, 132,000 in 2005, 122,000 in 2006.

The Dirigo Health Agency’s administrative costs were $3.7 million in calendar year 2007.

Because of financial difficulties, DirigoChoice was closed to new enrollees on Sept. 1, 2007.

The 1.8 percent health care claims tax, which was included in the tax increase package approved by the Legislature, will cost individuals about $78 and families about $210 a year in higher health care premiums.

Without the $57 to $72 million tax increase, DirigoChoice enrollment is projected to drop by 4,000 individuals. Even with the tax increase, DirigoChoice enrollment still is projected to drop by 1,000 people.

The Dirigo Health experience has cost Maine taxpayers more than $100 million since 2005.

Dirigo Health was supposed to make health insurance more affordable and provide coverage for most of Maine’s uninsured. In fact, it has done neither.

Labels: ME, States

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Maine has recently joined the growing list of failed state reforms. As with other faillures, the Dirigo Care program was shoved down the throats of a bewildered legislature by an egotistical governor who promised Nirvana.

...But look behind the spin and the report is a devastating examination of a program that was poorly conceived and doomed to fail from the beginning – as many of us had predicted. It finds: 1. After 20 months of operation only 11,000 were enrolled in DirigoChoice (out of a total uninsured population of 136,000), and over two-thirds of these were already covered. 2. Of the small companies eligible to participate, only 2.5% actually did. 3. The financing scheme (a “savings offset payment”) is impossible to measure or implement. 4. Almost as many people (3,600) had disenrolled from the program as were newly insured by it.

Labels: ME, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: ME, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis