Maine Enacts Universal Access To Health Coverage Plan
First In The Nation Law May Be A Model For Other States

by Joseph P. Ditré, Esq., Ex. Dir.,
Consumers for Affordable Health Care
Last updated on 6/1/04

The distinguishing feature of Dirigo Health is that it combined access expansions with significant health care and health insurance cost controls and quality improvements. Dirigo Health provides individuals and small businesses (2 - 50 employees) with an affordable, comprehensive health insurance product that they can buy like any other insurance product. Participation in Dirigo Health is voluntary. Policy analysts believe Dirigo Health will become a market leader because of its lower costs and better benefits. If successful, Dirigo Health will effectively merge the non-group and small group markets in Maine into one large risk and payment pool. The differences that make Dirigo Health more attractive when compared to other private plans are notable - the projected prices are lower, the benefits are comprehensive and there will be subsidies available to workers with incomes between 200% - 300% of the federal eligibility guidelines. If a small business decides to participate in Dirigo Health, the business will be required to contribute up to a maximum of 60% of the total charges of the coverage for the employee and/or their dependents. For example, the employer share for a single adult will be $180 or 60% of the $300 total charge. If the employee does not qualify for a subsidy, s/he will pay the remaining $120. If the employee qualifies for a subsidy, their contribution may be as low as $25 per month. In addition, MaineCare (Maine's Medicaid program) will cover parents and children up to 200% FPL and adults without children up to 125% FPL. Cost controls on hospital, physician and insurer prices play a fundamental role in sustaining the affordability of the plan. While much remains to be worked out, the plan provides consumer advocates with the opportunity to work with small businesses and to build a strong basis for cost containment, quality improvement and access expansions as a package. For more information Dirigo Health, call 1-800-838-0388.

Return to Coalition News