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Summary: A compromise combination Plan A will go into effect later this
year. After three years, if it
does not demonstrate a reduction in number of uninsured, Plan B will go into
effect. Hopeful small steps
forward. - KWC Innovative health
bill embraced AUGUSTA — State lawmakers embraced
one of the nation's most ambitious attempts at health-care reform Friday,
passing a bill that promises affordable coverage to all Mainers within five
years while controlling health-care spending statewide. National policy
analysts have described the bill's focus on access, cost and quality as groundbreaking at a time when other cash-hungry states
are taking slower, more cautious steps. Others attach "first-in-the-nation" to the
bill's centerpiece, the state-sponsored Dirigo Health insurance program that
would use the state's buying clout to offer low-deductible but comprehensive
health plans through private insurance carriers. The program would subsidize
premium payments for income-eligible enrollees. Gov. John Baldacci - who
introduced the bill May 5 and pushed for its passage this session despite
protests from Republicans, the health care industry and members of the business
community - said the legislation could become a national model. “We send a message not only to our
citizens but to others, that this is the way things should be done," he
said. Carla Plaza, health policy analyst
at the National Conference of State Legislatures, said Maine is leading other
states. "The governor has
taken bits and pieces of what other states are doing and incorporated it into
one huge plan," Plaza said. "I don't think any other state has done
something like this." The House of Representatives voted
105-38 on the final version of the bill, the Senate 25-8; despite partisan
rifts, both bodies easily reached the simple majority required for passage. The
bill takes effect 90 days after the Legislature adjourns, as early as today. After weeks of work sessions and
deal-brokering behind closed State House doors, final enactment in the Senate
on Friday drew applause from supporters, who said the health-insurance program
- coupled with an expansion of Medicaid - will cover the estimated 180,000
Mainers who go without insurance each year. "It's a great day for people
who can't afford the high cost of health-care coverage because help is on the
way," said Joe Ditre, executive director of Consumers for Affordable
Health Care. Democratic Sen. Sharon Treat, the
bill's chief sponsor in the Senate, said the program aims for the same goal of universal health care
as a single-payer health-care system, a
controversial measure being studied by a legislative panel. But, she said, Dirigo Health is not "disruptive to the current system we
have." The program is funded by
contributions from employers and employees who can afford to pay, federal money
and an annual fee on insurance carriers to recover the tens of millions of
dollars of bad debt and charity care normally incurred by the uninsured and
ultimately shifted onto the premiums paid by insured individuals. The governor has pledged about $53
million in federal funds for the first year of the program, which would start
on July 1, 2004. "One of the key features is
that it's a combination
of public- and private-sector resources and market forces," said Sen. Michael Brennan, D-Portland, co-chair of the
bipartisan Joint Select Committee on Health Care Reform, which unanimously
endorsed the bill. Other groups
had mixed feelings about the bill's enactment, saying they hope the plan will
work but have their doubts. The Governor's Office says a
Dirigo Health premium for an individual will likely cost under $300 a month, but some business associations wonder whether employers
will be able to contribute up to 60 percent to participate, or whether
uninsured individuals who have been relying on charity care from hospitals will
want to buy insurance. They also worry that an annual fee
on insurance carriers will be passed on to premium payers, despite assurances
from the Governor's Office that safeguards will make it unnecessary for any
cost-shifting. Also concerned were lobbyists for
Maine's health-care industry, which publicly supported the bill only after the
Baldacci administration relaxed some cost-containment measures. Among the bill's provisions is
that insurers, doctors and hospitals adhere to voluntary 3 percent caps on revenue increases. There are
also tighter restrictions on medical expansions that doctors and hospitals can undertake. Hospitals, which also face a voluntary 3.5
percent cap on price increases, might
have to consider cutting back health-prevention programs and reducing salaries,
according to the Maine Hospital Association. "We don't know how much fat
there is out there, but we'll soon find out," said association president
Steve Michaud, who says he plans to meet with members this summer to assess the
plan's impact. Many Republicans questioned
whether the law will be able to contain costs, but voted for it because of
amendments made in work sessions. To help win a unanimous
"ought to pass" report from the health-care reform committee, the
Baldacci administration agreed to a provision that would let the Legislature
consider a high-risk
pool model if Dirigo Health performed
unfavorably. That insurance model, found in 31 other
states, separates the sickest individuals to bring down
premium costs for other premium payers. Dirigo Health would have to show after three years whether it is
helping to reduce the number of uninsured Mainers
and whether it is reining in insurance costs. "We
do have a 'Plan B,' and that
gave us a lot of comfort," said Rep. Kevin Glynn, R-South Portland, who
sat on the health-care reform panel. The governor was ready to begin
making appointments this summer to the Dirigo Health board and an advisory
committee on quality, but that will now happen after September. The start date
was pushed back when Republicans voted against a version of the bill that
contained an emergency provision. The votes were close. Rep. Joe
Bruno, R-Raymond, House Minority leader, said the bill could have been passed
with the "emergency preamble" if another vote were taken. Aides say Baldacci will hold a bill-signing
ceremony next week, when members of his health care team - Trish Riley,
director of the Office of Health Policy and Finance and the chief author of the
bill, and deputy director Ellen Schneiter - will be available. Staff Writer Josie Huang can be
contacted at 791-6364 or at: [EMAIL PROTECTED] http://www.pressherald.com/news/statehouse/030614health.shtml |
