DirigoChoice is part of Dirigo Health, a comprehensive set of reforms enacted with the goal of providing all Maine residents with access to health care by 2009. (Dirigo is Maine's state motto, meaning "I lead.") Dirigo Health aims to do more than insure the poor and subsidize coverage for those who need it. It is designed to contain costs through efforts such as reducing bad debt and charity care, creating a capital investment fund, exercising tighter oversight on growth and expansion of health care facilities, and providing financial incentives for consumers to choose cost-effective providers. It also aims to improve quality by using information technology, including electronic health records, throughout the state. The new Maine Quality Forum, meanwhile, serves as a clearinghouse of best practices and related health information.
Dirigo Health has been controversial since its inception. It has claimed $43.7 million savings during its first two years. Under the program's financial structure there is a tax on insurance premiums equal to the savings offset. The Commonwealth Fund is supporting an evaluation of Maine's initiative.
The Fund is also supporting an evaluation of a newer initiative in Massachusetts. We hope to learn from these efforts to make financing coverage a shared responsibility of employers, state and federal government, and individuals. But public policy changes at the national level and increased federal financing are likely to be needed to extend these approaches to states with higher rates of uninsured and more limited ability to fund coverage from local sources. A forthcoming Commonwealth Fund analysis of national health legislative proposals introduced in Congress will lay out a wide range of ideas for consideration.(5)