Maine, a trailblazer in controlling prescription drug costs, is now poised to provide universal health care for its residents. Leading the charge is Democrat freshman Gov. John Baldacci.
The three-pronged voluntary plan known as "Dirigo Health," (Dirigo is Latin for "I Lead") focuses on health care access, quality and cost control. It passed the Legislature June 13 and Baldacci signed it five days later.
Starting in July 2004, Maine will provide insurance subsidies to individuals and families on a sliding scale based on income. Those who make up to 300 percent of the federal poverty level will be eligible that's up to $27,000 for an individual and $55,000 for a family of four.
With the subsidy, residents can purchase coverage through private health insurance carriers. Maine also hopes to expand its Medicaid program, the state-federal health insurance program for the poor and disabled. Some 31,000 uninsured people will get health care benefits during the first year of the program and up to 180,000 of Maine's 1.2 million residents will be covered by 2009.
Its first year, Dirigo will be funded in large part by about $53 million the state received from the federal government as part of the Bush tax cut package that Congress approved earlier this year. Small businesses will pay up to 60 percent of the cost of insuring their workers and insurance companies will pay the state up to 4 percent of their premium revenue.
In subsequent years, the state hopes the program will pay for itself. Uninsured residents who use emergency rooms for health care services -- which contributes to what the governor calls "bad debt and charity care" -- cost the state about $275 million per year. The governor hopes that these costs will be reduced and that about 30 percent of these savings will roll back into funding the plan.
At the National Governors' Association's meeting in Indianapolis last week, Gov. Baldacci sat down with Stateline.org and talked about his health care initiative.
Here are some excerpts from the interview:
STATELINE.ORG: (Regarding) the health care plan you unveiled recently -- Is this something you campaigned on?
BALDACCI: "During the campaign, people in Maine were talking to me about the cost of health care. It really became a statewide issue. We had to figure out policies that would be beneficial for families and small businesses for more affordable health insurance. More and more of them could not afford the crushing burden that these increases were putting on top of them. Businesses were putting more pressure on workers because the businesses couldn't afford the co-payments or the family plans. It became an economic issue. If the businesses can't have the workers and the workers can't have the health care, they're going to go elsewhere."
STATELINE.ORG: You said you spoke with health care providers, businesses and insurance companies throughout this process. What were some of their concerns?
BALDACCI: "A lot of them felt that it was a great idea, but they were trying to make sure that they could sort of be standing by the wayside and not be in the mix. But I assured them that we were all in this together and no one was an island unto themselves. That is still a challenge. They know it needs to be done, and they know that we've probably got a pretty good basis for it, but they'd like to see it happen without having any kind of direct impact on them.
STATELINE.ORG: What was the Legislature's response to the plan?
BALDACCI: "I think the people in the Legislature knew it had to be done and they showed leadership for that. Sometimes the interest groups in the background raised the noise level and sometimes it's hard to get the focus that you need ... You can't tell a doctor, a nurse or a hospital administrator how to deliver health care. You've got to have them be supportive and working with you."
STATELINE.ORG: What happens if uninsured people don't sign up and you don't get the return from bad debt and charity care' that you're counting on to fund the program?
BALDACCI: "This is not an end-all-be-all. It's one that I feel strongly about and has been researched and what have you. But working through the process people say, Well if this doesn't work out after a year can we try high risk pools, can we try some other type of plan?' We're going to continue to experiment, we're going to continue to push the envelope and we're going to continue to reach out to everybody."
STATELINE.ORG: So you're not opposed to a "Plan B"?
BALDACCI: "No, we have to figure this out. This is a collaborative effort in our state. One thing I've realized as governor, you're really chairing a town meeting. People in Maine are part of this process. They want (universal health care) to happen and if this doesn't work, we'll try Plan B or we'll try Plan C. I believe very strongly that this will work, but it's more important that we do things that will be helpful to citizens whether it's somebody else's idea or comes from some other place."
STATELINE.ORG: Do you think Maine will serve as a model for other states?
BALDACCI: "Good, bad or indifferent, all eyes are on Maine. That's why it was so important to work with the Legislature and the business community and the health care community and consumers in Maine to make sure that we were putting forward a substantive, well-researched proposal ... it's been pushed and pulled and analyzed and it holds great promise, now let's see what happens in the delivery."
STATELINE.ORG: Do you think there are some unanswered questions?
BALDACCI: "There's no question there are some unanswered questions, but we have to move forward. I tell people that the status quo is unacceptable. When I have businesses and individuals who are telling me that they can not afford the crushing burden of health care costs and they're worried about losing their workers, they're worried about losing their businesses, then it's a call to action. It must be thoughtful action. It can't be irrational action."
STATELINE.ORG: Do you think universal health care will happen on the national level anytime soon?
BALDACCI: "I think you're going to see in the presidential campaign that health care will be much more of an issue ... Health care is really more and more an issue that cuts across parties, that cuts across ideologies in regions of the country and the state. Health care is becoming an issue, affordable health care. I think people are now trying to scramble to address that.
STATELINE.ORG: Do you think universal health care specifically will be an issue?
BALDACCI: I do. To be the only industrialized country in the world without available health care and being in competition in the global marketplace where other countries are doing it or are engaged in it puts us at a disadvantage."