James M. Verdier, Debra J. Lipson, Lynn Quincy
D. J. Lipson, J. M. Verdier, and L. Quincy, Leading the Way? Maine's Initial Experience in Expanding Coverage Through Dirigo Health Reforms, The Commonwealth Fund, December 2007
In 2003, Maine adopted the Dirigo Health Reform Act, which aimed to make affordable health care coverage available to every Maine citizen by 2009, slow the growth of health care costs, and improve the quality of care. "Dirigo," the state's motto, meaning "I lead" in Latin, is a fitting name for the program. At the time the legislation passed, Maine was the first state since the early 1990s to enact comprehensive health care reform legislation and to set a goal of providing affordable health insurance coverage to everyone in the state.
Since then, several other states, notably Massachusetts and Vermont, enacted ambitious health reform and universal health coverage legislation, and Illinois adopted legislation to cover all children. In 2007, more than a dozen states considered proposals that strive for universal health coverage. Lessons from Maine's experience implementing the Dirigo Health program could be useful to these and other states in their efforts to expand insurance coverage.
Is Maine leading the way toward universal coverage? This study examined interim indicators of Maine's progress in providing affordable health insurance coverage after two years of program implementation, midway between the legislation's adoption and its 2009 goal. (The study's research methods and data sources are described at the end of this report.)
The evaluation focused on the states progress in implementing Dirigo Health's two major coverage initiatives: 1) DirigoChoice, a subsidized health insurance program, initiated in January 2005, for eligible small businesses, self-employed workers, and individuals; and 2) an increase in the annual income eligibility level (from 150% to 200% of the federal poverty level, or FPL) in the states Medicaid program (called MaineCare) for parents of dependent children under age 19.
These two initiatives built on a series of previous Medicaid eligibility expansions, including a program started in 2002 to cover childless adults earning up to 100 percent FPL. The Dirigo Health Reform Act authorized expanded eligibility for this group to 125 percent FPL, but it was not implemented due to budget constraints related to the terms of a federal Medicaid waiver. However, this study examined enrollment trends among childless adults since that program operated concurrently with Dirigo expansions and offered another avenue for coverage gains among low-income individuals.
The complete report, including information about the study methods, can be found on Mathematica's Web site at
To read an interview with the study authors, see The Lessons of DirigoChoice.