June 20, 2018
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What If Dirigo is Dirigone?

Tarren Bragdon, a member of Gov.-elect Paul LePage’s transition team, bragged to The New York Times last week that Maine’s beleaguered health care program would soon be “Dirigone.”

It made for a nice sound bite, but before deciding to ditch the Dirigo Health program, Mr. Bragdon, Mr. LePage and others should find out what the program has accomplished.

While Dirigo has long been a whipping boy for Maine’s Republicans — some criticism is justified — there are positive aspects of the program that may be worth keeping.

When most people think of Dirigo, they think of its subsidized insurance aspect, which aimed to reduce the number of people without health insurance in Maine. This part of Dirigo was doomed from the start.

Dirigo was initially funded by a so-called savings offset payment required of insurance companies. The savings offset payment was a calculation of the health care savings for insurance companies and hospitals resulting from Dirigo reforms, which include quality improvements and cost reductions. The savings were used to extend health care policies to those without insurance.

The Maine State Chamber of Commerce and Anthem Blue Cross, which was the Dirigo insurer until 2007, filed numerous legal challenges to the savings offset payment. Although the payment has been upheld by the courts, calculating and defending it costs the state between $3 million and $5 million a year.

Gov. John Baldacci and Democratic lawmakers sped up Dirigo’s disintegration last year when they agreed to drop the savings offset payment and replace it with a surcharge on insurance claims. This broke the connection between Dirigo’s quality and cost-cutting reforms and increasing insurance coverage.

A part of Dirigo that is often overlooked is the Maine Quality Forum, which provides the public with information on costs and quality to help them determine which doctors and hospitals they may want to use. In part because of this work, Maine was ranked No. 1 for health care quality improvement last year. In its annual evaluation, the Agency for Healthcare Research and Quality, which is part of the U.S. Department of Health and Human Services, ranked Maine fourth in the country for health care quality, a big jump from 12th the previous year.

The biggest gains came in diabetes and home health care. For patients with these and other conditions, these are real improvements in their lives, improvements that shouldn’t be disregarded to score political points.

This week, the federal Centers for Medicare and Medicaid Services committed up to $26 million additional funding to support Maine’s work in improving patient care. Maine is only one of eight states to participate in the project, which is aimed at increasing preventive and primary care, while reducing emergency room visits, one of the top reasons for rising medical costs and a focus of the Quality Forum.

Dirigo has many problems, but pledging to kill the entire program — especially when something like it will need to be created as part of the national health care reform — is the wrong way to reduce health care costs and improve medical care in Maine.

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