The Dirigo Health board of directors Monday began reviewing a $100 million estimate of how much has been saved on health care as a result of the Dirigo subsidized insurance and cost control program this year, laying the groundwork for how much of an assessment, or so-called Dirigo tax, could be charged in 2007.

The maximum allowed for the assessment under law would be $80 million, if the superintendent of insurance agrees that much or more has been saved because of Dirigo.

It would affect consumers because the assessment is on private health insurers – the largest being Anthem – and the self-insured, and could be passed down in the form of higher rates.

During the day-long hearing on Monday, the board began reviewing numbers presented by the state’s consultants and fielding questions from a panoply of lawyers representing insurance companies, the self-insured, the business community, advocacy groups and the state. A decision on the number the board will recommend is due by the end of the week.

Last year, Insurance Superintendent Alessandro Iuppa ruled Dirigo Health had only saved $43.7 million even though the Dirigo Health Agency had originally estimated savings of $137 million.

The final math won’t be figured out for months since the Dirigo Health agency has to jump through several regulatory hoops and ultimately decide how much money it needs to keep the DirigoChoice subsidized insurance program going in 2007. The program currently insures 9,734 Mainers.

There is also legislation pending that would cut this year’s assessment in half and set up a commission to study alternative funding methods. That bill will be taken up again when the Legislature returns from break on May 22.

Karynlee Harrington, the head of the Dirigo Health agency, said the $100 million estimate, prepared for the state by its consultant Mercer, is somewhat misleading because all the data isn’t in yet. The final estimated savings could go up or down.

The savings matter because the state can charge no more than what’s been saved. The assessment is also capped at 4 percent of paid commercial claims – not including Medicaid or Medicare – which totaled around $2 billion in Maine last year. That 4 percent is $80 million.

Kristine Ossenfort of the Maine State Chamber of Commerce, which sued the state along with a coalition of insurers over last year’s assessment, said the number appears high.

“I’m a bit surprised at the $100 million given the superintendent’s ruling last year, which was only $43.7 despite the fact they had started with a filing of $137 million,” she said.

The chamber and insurers have questioned what the state is counting as savings, arguing it should be only the avoided costs of bad debt and charity care as a result of DirigoChoice insuring the uninsured.

According to a report done for the state by the Mercer, there are five major areas of savings being counted to make up the $100 million estimate. That number could change once more data is available after the fiscal year ends on July 1.

The estimates include:

• $72.7 million in savings in hospital charges

• $2.7 million in avoided bad debt and charity care because DirigoChoice now covers some previously uninsured

• $3.9 million in avoided bad debt and charity care because the Dirigo Health legislation allowed for an expansion of Medicaid to cover more than 4,000 adults, who are believed to have been previously uninsured

• $5.4 million in avoided hospital construction costs thanks to limits put on capital investments

• $15.2 million in increased or more timely payments to hospitals and doctors for their Medicaid patients

Ossenfort said the low number attributed to bad debt and charity care for DirigoChoice members, and the fact that Medicaid enrollment savings trump that number, is not a good sign.

“It seem to indicate that Dirigo is not having the impact that one would have hoped,” on insuring the uninsured, she said.

The original goal of the program was to cover the state’s 130,000 uninsured in five years.

Harrington said her agency is eager to do a redesign of the insurance coverage to offer a lower-cost policy that will attract more people into the program.

“I’m very anxious to get started on our plan redesign so we can get a lower cost product to market,” she said.


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