Dirigo Health Reform Myths vs. Facts Myth: Dirigo isn't meeting enrollment goals. Fact: DirigoChoice is the fastest growing insurance product in Maine. Anthem has reported that enrollment rates in Dirigo are significantly higher than other new programs. Myth: The State spent $53 million to cover just a few people. Fact: $29 million of the original $53 million remains as of January 1, 2006. Dirigo served over 13,000 people in 2005 – 8,676 DirigoChoice members and 4500 MaineCare parents. And, these funds support the Maine Quality Forum. As of February 1st, 9,270 Maine people are enrolled in DirigoChoice, including 2000 businesses across the state. Myth: DirigoChoice is failing to cover Maine's 130,000 uninsured people. Fact: Dirigo Health Reform uses three strategies to reduce the uninsured. Cost containment to ensure employer sponsored coverage is affordable MaineCare expansions and DirigoChoice Myth: Maine isn’t succeeding in reducing uninsured. Fact: Maine is one of 7 states and the only New England State to reduce its number of uninsured between 2000 and 2004. 8,000 fewer Maine people are uninsured. New Hampshire saw 48,000 people become uninsured during the same period. Myth: I work for a big business which doesn’t qualify for Dirigo. Dirigo Health is doing nothing for me. Fact: Dirigo Health is much more than a health insurance program. It is making health care more affordable and of better quality for all Maine people through the State Health Plan and the Maine Quality Forum and other initiatives of Dirigo Health Reform. Myth: My company has coverage. We looked into DirigoChoice and none of us qualified for discounts. It's not cheaper. Fact: DirigoChoice is not designed for you. DirigoChoice is designed for uninsured and under-insured Mainers – those with high deductible policies. Most uninsured work in small businesses or are self-employed. And, 80% live below 300% of federal income levels (roughly $29,000/single adult and $58,000/family of four). DirigoChoice is available to small businesses, the self-employed and individuals. DirigoChoice members living below 300% of federal income levels receive discounts on premiums and deductibles. Myth: DirigoChoice isn't covering enough uninsured. Subsidizing businesses that had coverage is bad policy. Fact: A survey of DirigoChoice members receiving discounts shows that 44% were uninsured sometime in the year before they joined Dirigo. Myth: Some businesses had coverage prior to DirigoChoice. Subsidizing businesses that had coverage is bad policy. Fact: The majority of members with prior coverage were under-insured because they had high deductible policies. And, as a matter of fairness, businesses with prior coverage are eligible. It would be unfair to businesses that compete with each other if only one were eligible for DirigoChoice and its discounts. Myth: Dirigo Health did not save the health care system any money. Fact: The Superintendent of Insurance ruled that Dirigo Health Reform saved the health care system $43.7 million. He ruled that the savings are “recoverable” and insurers and hospitals should “negotiate in good faith to pass these savings through to consumers.” And, there was a 9.4% drop in the rate of increase in hospital charges between 2004 and 2005. Myth: The Savings Offset Payment is a tax on premiums. Fact: The Savings Offset Payment is paid for with savings in the health care system. If there were no savings, there would be no payment. Dirigo Health saved the entire health care system $43.7 million. Insurers should negotiate with hospitals to capture those savings and share them with the people of Maine. Myth: A high risk pool would make premiums cheaper in Maine. Fact: High risk pools only impact the individual market. A high risk pool would do nothing for Maine businesses. Only 5% of Maine people are covered in the individual market. 60% of Mainers are covered by the small and large group markets. Myth: New Hampshire premiums are cheaper than Maine's. Fact: NH premiums for small business were higher than Maine's from 1998-2003 (the most recent year data is available). NH Large business premiums were higher for 5 of those 6 years. In the individual market, what you'd pay in each state depends on who you are – a 45 year old man would pay $646 per month in ME but $322 in NH while a 30 year old woman needing maternity coverage would pay $517 in ME and $575 in NH. Myth: Maine isn't succeeding in reducing uninsured. Fact: Maine is one of 7 states and the only New England State to reduce its number of uninsured between 2000 and 2004. 8,000 fewer Maine people are uninsured. New Hampshire saw 48,000 people become uninsured during the same period. Myth: Premiums in Maine are high because of Maine's insurance regulations like guaranteed issue and community rating. Fact: Self-insured companies are not subject to state regulations or mandates but still report high costs. So, factors other than regulation drive costs. Even though it is self-insured, UnumProvident says: "Our employees in Maine are healthier and have lower utilization than employees we have in other places; yet, despite that rosy picture, our overall costs for Maine employees is higher than for our employees in other states." Myth: We shouldn't expand MaineCare. Fact: MaineCare is the most fiscally responsible way to expand access to coverage for low-income Mainers. For every dollar the state spends on MaineCare, we get $2 from the federal government. GOHPF 2-9-06 Download this page as a two-page Word document