While Massachusetts and now California may get all the press, Maine continues its quest for equality in health care.
Before universal health care fever swept Massachusetts and then California, there was Maine. In June 2003, Maine Governor John Baldacci signed the Dirigo Health Reform Act into law with the ambitious goals of controlling costs, improving quality of health care, extending insurance coverage—and providing all Maine's citizens with access to health care by 2009. The law went into effect Jan. 1, 2005.
The act also created a new health plan, DirigoChoice, which provides discounted health insurance coverage, on a sliding scale, to Maine businesses with 50 or fewer employees, the self-employed and individuals.
The first steps toward health care parity?
The state paid $53 million to launch the program. Further funding was to be found from the cost savings by Maine's hospitals and to insurance companies—from fewer E.R. trips by the uninsured among other savings. The plan called for an evaluation of those savings and then for the insurance companies to pay that cash back into the Dirigo system.
The Maine legislature had hoped to have 30,000 enrolled by the end of the first year; but enrollment is now only at about 15,000, says state Rep. Hannah Pingree, (D-North Haven).
"It's not a failure, but it hasn't been as successful as we would have hoped," says Pingree, vice chair of the health committee of the National Conference of State Legislatures. "For a small, poor rural state, we've done some great and really innovative things."
Needed—a national solution?
But, achieving equality in health care, as the Clinton administration discovered, is no easy matter.
"We've had a hard time making it affordable enough, and middle income people don't qualify for a discount, so they are still left out of the system," Pingree says.
A blue-ribbon panel recently recommended the state identify new funding sources that will come through the state budget, such as increased taxes on tobacco products, snacks, bottled soft drinks and beer and wine.
While states like Maine, California and Massachusetts attempt to assume responsibility for their uninsured, universal health coverage is not something that can be strung together, piecemeal, state by state, Pingree says. The federal government, she says, must come up with a national solution, in terms of both money and policy changes.
"The lower middle class is continually being squeezed out—they don't qualify for Medicaid, but many can't afford insurance at all, or only a policy with a very high deductible," Pingree says. "They don't have access to preventive services and they have to pay a lot of their health care so they end up in worse medical shape."
In the meantime, the majority of Maine residents still back the Dirigo plan, Pingree says.
"It's been controversial, but there is strong support to continue what we are doing," she says, "Health care security is probably one of [constituents'] top three concerns."