Maine's Dirigo Choice Experimental Health Insurance Plan

Maine requires community rating ( all the insured pay the same premium for the same insurance coverage under each policy choice ) and no discimination due to pre existing conditions.  This has driven insurance companies out of the Maine market and increased premiums by those few insurer's willing to cover Maine citizens.

In an attempt to improve the situation the legislature enacted Dirigo Choice which was designed to provide access and subsidies, particularly for small business, the self employed and individuals without any coverage. Due to the instability of the funding mechanism the program has been closed for two years to new subscribers. It is currently managed by Harvard-Pilgrim (a non-profit). The rising costs of medical care have driven up the monthly premiums and increased the amounts to be paid out of pocket.
As members drop out due to age, attrition, inability to pay premiums or return to covered employment, the number of covered members is declining. For those without other healthcare insurance options Dirigo has been a lifesaver.  In the early days of Dirigo Health many potential members were not able to pay the full upfront premium and then wait to be reimbursed for their subsidy amount later.  That system has since been corrected.

As we look at expanding health insurance coverage to more Americans much can be learned by looking at the states that have tried to do just that.
We know that Senators Collins and Snowe will give thoughtful consideration to the plans being formulated in Washington and will throw a life ring to those who need the help of a public option.
Harvard Pilgrim                         Dirigo Health - Maine People's Alliance

America’s Healthy Future Act of 2009

In the current version of the Finance Committee's Chairman's Mark there is no mention of Alzheimer's and only two of dementia. 

1. It would establish within the Centers for Medicaid and Medicare Services (CMS) a program to test and evaluate patient-centered delivery and payment models. The Center would consider models that target beneficiaries with multiple chronic conditions and at least one of the following: (1) an inability to perform 2 or more activities of daily living; and (2) a cognitive impairment, including dementia.

2. Dementia and Abuse Prevention Training. The Chairman‘s Mark would add staff training requirements for nursing homes. The Secretary would revise initial nurse aide training, competency, and evaluation program requirements to include dementia management training and patient abuse prevention.

The Finance committee will vote on the bill this coming week. The draft will have to be merged with other committee's efforts before going to a full Senate vote later this month. Later it would be off to conference with the House version.

Full text of the bill >>>


http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf

The Question of Universal Coverage

Here we are now, with Alzheimer's, Medicare and no insurance coverage for needed services - aides and attendants, case managers and social workers , physical therapists and community centers and nursing homes.

To be effective insurance has to include a very large group. Health insurance doesn't work the way other types of insurance do. We know in advance which members are more likely to need care . The young ones and the old ones and those with existing conditions. These groups are often the least able to pay and so an imbalance between needs and resources is created . Since insurance companies know this they tend to exclude or over price their policies in an attempt to cover only that population with a low risk of filing claims. That is their business model.

As Congress wrestles with the appropriate role of government in the protection of it's citizens we hope they will consider home and long term care coverage. With an aging population and increases in dementia and Alzheimer's cases this is a growing problem for sufferers and caregivers who right now have to muddle through on their own.

With thanks to > > > http://www.metaphorcountry.com/dementia_nights/2009/03/healthcare-reform-notes-i-alzheimers-universal-coverage-longterm-care-1.html