Earlier this year, the Legislature enacted and Governor John Baldacci signed into law the nation's first universal health care program. Over the next five years, the Dirigo Health Program will provide coverage to the 180,000 Mainers who are currently without health insurance and, equally important, reduce health care costs for everyone. By utilizing a innovative blend of private and public resources, Maine has catapult itself to the forefront of progressive health care reform.

In Maine we waited for help from the federal government. Help to reduce the cost of health care, help for those without coverage and help to lower the cost of prescription drugs. We decided not to wait any longer.

A statewide poll conducted in 2000 revealed that health care was as the most pressing concern to Maine citizens. Further analysis of the poll showed that 69 percent of respondents were very concerned about the cost of health insurance, placing that issue at the top of the list of concerns. The cost of medical care came in second followed by prescription drug costs and the cost of caring for the elderly. These issues all ranked ahead of education, taxes, crime and the environment. A survey of Maine small businesses, also released in 2000, indicated that they too were concerned about the rising cost of providing health care coverage to workers. A large majority, 81%, indicated health insurance was important in their efforts to attract and retain employees.

For the past several years, Mainers have been subject to annual double digit increases in health insurance premiums. In fact, this year it is projected that across the country employers will experience a 15% increase in health care costs. Given escalating premiums, and confronted by a slow economy, employers have been challenged to maintain their current level of employer-based coverage. Already, workers have been asked to bear more of the cost of coverage, either in the form of higher co-payments or deductibles, or to forego wage increases in an effort to maintain health coverage.

Very tight state and local government budgets have further compounded the problem. With annual double-digit increases in health care costs for government, school systems, and university employees, flat-funded, balanced budgets require real cuts in programs to offset the increases. For a rural state such as Maine, these spiraling health insurance costs have become a major drain on the state's human and financial capital.

Faced with this dire situation, two years ago the Maine Legislature authorized the creation of a Commission to examine a single payer system. This proposal was hotly debated in the 2002 Gubernatorial election that included Democratic, Republican, Independent and Green candidates. Shortly after taking office, Democratic Governor John Baldacci announced his intention not to pursue a single payer system and, instead, to introduce the Dirigo Health Plan and created the Office of Health Policy and Finance to shepherd the bill through the Legislature.

When the bill was first introduced in May, it was widely supported by consumer groups and health care activists but faced strong opposition from the hospitals, insurance companies and physicians. In order to avoid a potential stalemate between organizations who want progressive reforms and the status quo, Maine's Legislative leadership took the unusual step of establishing a bipartisan Joint Select Committee on Health Care Reform. Members were selected from the Legislature's Health and Human Services, Insurance and Financial Affairs, and Appropriations Committees. The Committee, which had broad authority, was given just over a month to fashion a compromise and revamp the state's health care system. Following a series of public hearings and late night negotiations, the Joint Select Committee unanimously approved a rewritten version of the Governor's proposal.

The newly created Dirigo Health is based on the premise that by providing health coverage to all residents, the health care system can recapture a major portion of the $270 million that is now lost in emergency room and uncompensated care. Dirigo Health will:

• Provide an affordable, comprehensive benefit plan to individuals and small businesses by July 2004.
  
• Help control the cost of health insurance through more rigorous rate setting.
  
• Allow insurers more flexibility in negotiating rates based on quality standards.
  
• Improve health care planning by developing quality data.
  
• Help contain costs through voluntary caps on health care providers for a period of one year.
  
• Enroll 14,000 new persons in Maine Care (Medicaid) by expanding eligibility for individuals without children and working parents.

Dirigo Health is a quasi state agency with a five member Board nominated by the Governor and approved by the Legislature. The Board is now in the process of developing a benefit plan and will issue a request for proposal next year for a private carrier to administer the plan. By this time next year, Dirigo Health expects to enroll over 30,000 uninsured Mainers.

In addition to Dirigo Health, the U.S. Supreme Court also awarded Maine a significant victory this spring when it ruled that the Maine Rx Program could be implemented. The program, passed by the legislature in 2000 was immediately challenged in court by the pharmaceutical companies. Due to the Courts ruling, Maine will be the first state in the country to extend prescription discounts to an additional quarter of a million of its citizens.

In Maine we waited for help from the federal government. Help to reduce the cost of health care, help for those without coverage and help to lower the cost of prescription drugs. We decided not to wait any longer. Instead, we are on the cusp of transforming health care in this state to ensure that all residents-regardless of income or education-have access to quality health care. We look forward to making Dirigo Health a success and we would welcome the opportunity to work with other states or organizations interested in pursuing progressive health care reform.

Senator Michael Brennan represents Maine Senate District 27, which includes Portland, Falmouth and Long Island. He is Senate Chair of the Joint Select Committee on Health Care Reform and the Standing Committee on Health and Human Services. He can be reached at SenMichael.Brennan@legislature.maine.gov or at the Maine Senate Majority Office at 207-287-1515.

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