Dirigo critics inflate their numbers and propose shutting people out of the health care system.

I was surprised to read the guest column of certain elected officials calling the MaineCare program “obese,” suggesting that too many people are covered by it and that it should be cut (Jan. 25).

Ask the family of the nursing home resident, the person with a permanent disability who can’t work, the family struggling with a member with mental illness or the parent working for $8 an hour with no health benefits whether the program should be severely cut, and you will hear a resounding “no.”

Then think a minute and ask the struggling business person whether they would like to have all those people with high health care costs left without insurance, showing up at the emergency room and having those costs passed on by hospitals to private insurance premiums. The thoughtful answer is also a resounding “no.”

The Republicans on the Appropriations Committee have recently proposed to delay for more than a year the Medicaid expansions that are scheduled to take place as part of the Dirigo Health plan. This, too, would be a big mistake.

Here are some of the reasons

MaineCare provides enormous value for Maine’s dollar:

Maine receives two federal dollars for every state dollar it spends in Medicaid. Many services, particularly mental health care that had previously been paid for with all state dollars, are now being paid for with the help of federal Medicaid dollars.

Medicaid serves as Maine’s “high risk pool,” helping to reduce health care costs in the private sector. Most Medicaid dollars go to serve those in Maine with the greatest health needs: nursing home residents and people unable to work due to disability. It also serves low-income working families who are less likely to have jobs that offer health care. All these costs are costs that are not shifted on to the private sector and would otherwise drive up private insurance premiums further.

Health care cost growth has been managed in MaineCare. In spite of astronomical growth in health care costs generally (particularly in prescription drug costs and hospital costs), MaineCare’s growth in costs has been significantly lowered by cost-effective management.

MaineCare has implemented numerous cost control measures, including:

• Aggressive negotiation of lower prescription drug prices;

• Aggressive use of prior authorization and preferred drug lists (some would say too aggressive);

• Incentives to physicians to encourage good preventative health practices;

• Lower rates, over all, to health care providers (many would say too low);

• Most MaineCare members are in a primary care case management program, connecting them to primary care providers and requiring them to obtain referrals for specialist care;

• MaineCare’s administrative costs are about one-third of that in the private sector.

Costs are rising in all health care sectors – not just MaineCare.

In the private sector, cost growth has been even more astronomical. The costs of comprehensive coverage for small businesses rose 58 percent between 1996 and 2001 according to the Maine Health Access Foundation Primer. Recent premium increases in small group market ran 15 percent to 20 percent in first quarter of 2003, according to Maine Bureau of Insurance data from November.

The Jan. 25 op-ed about the upcoming expansions in MaineCare is grossly inaccurate, implying that the program will grow astronomically in cost and numbers.

Here is the truth. Two groups of people are scheduled to get coverage under MaineCare when Dirigo Health is started on July 1 or soon thereafter. One group is the parents of the children who are already covered by MaineCare. These are parents with family income between 150 percent and 200 percent of the poverty line – between $22,890 and $30,520 gross income for a family of three.

The other group includes adults without minor children at home (“childless adults”) with income between 100 percent and 125 percent of the poverty level – between $8,980 and $11,225 in annual gross income. Because these groups are mostly working, they are relatively inexpensive to cover. Nowhere near the 78,000 spewed out in the Jan. 25 op-ed are expected to enroll. A closer estimate, according to the designers of Dirigo Health, is an enrollment of 12,700 in MaineCare in the first year.

How much will the new coverage cost Maine taxpayers on an ongoing basis? Nothing. The funding for the expansions will be paid for by the newly formed Dirigo Health Agency with a combination of federal dollars, voluntary employer contributions for health coverage for their workers and dollars set aside on a one-time basis for Dirigo’s start-up last year. The truth is a little different from what readers were lead to believe.

MaineCare is of enormous value for the state of Maine, bringing in hundreds of millions of federal dollars to make our health care system work for the most costly groups of people and for those who are in jobs where health insurance is either unavailable or unaffordable. Dirigo Health promises to take advantage of that system, while developing greater competition in the private market to help drive down private insurance rates.

Dirigo is good for business and good for employees. When it’s on the market, check it out and see if it’s the best deal going. And whether you buy it for your small business or not, be glad that there is another competitor on the market helping to control health insurance costs.

Rep. Margaret Craven is a Democrat from Lewiston.

Copy the Story Link