Negotiations on Governor's Dirigo Health Produce Compromise
An intense week of negotiations on the Governor's Dirigo Health Plan among the Governor's staff, MMA, the Maine Osteopathic Association, the Maine Hospital Association and the Maine Association of Health Plans culminated in a tentative agreement on Thursday, May 29th.
As you may recall, the Legislature's Joint Select Committee on Health Care Reform had sent the Governor's staff to negotiate with the three principal opponents of the plan (physicians, hospitals and insurers) before the Memorial Day Weekend. MMA and MOA staff and representatives of the state's 17 ambulatory surgical facilities began negotiations at 7:00am Tuesday, May 27th and significant progress was made by day's end. On Wednesday and Thursday, the MMA and MOA joined the other two stakeholder groups to review and approve compromise language offered by the Governor's office.
By Thursday afternoon, the group had reached consensus on the outline of the Governor's proposed compromise and physician, hospital and insurer representatives joined GOHPF Director Trish Riley in presenting the outline to the Committee. The three groups also attended the Governor's announcement of the compromise at a press conference in the Cabinet Room on Friday.
Like all compromises, there are aspects of the proposal that MMA would oppose if contained in a single bill. But the opportunity to go forward with the Governor, the Legislature and other interested parties in an innovative attempt to provide many of Maine's uninsured citizens with health insurance was a sufficient impetus to compromise on those aspects of the bill that we originally opposed, once the Governor indicated a real interest in negotiating acceptable language.
For physicians, the principle concessions made by the Governor's office are;
l. Restoration of the MaineCare Physician Incentive Program and a commitment to work on increasing MineCare reimbursement rates for all physicians.
2. Restoration of the exemption in the CON law for physician's offices and the division of the annual CON capital investment fund into a hospital and non-hospital pool.
3. Establishment of an inflation adjustment each year in the dollar thresholds for CON review.
4. Changes in the language in the bill easing the administrative burden associated with price disclosure, electronic billing and collection of quality data.
5. Acknowledgment that the 3% voluntary 'price' cap for physicians would apply only to net revenue.
6. Elimination of a global budget for Maine's hospitals, and elimination of that portion of the legislation calling for creation of a plan for the future of Maine's hospitals.
While this compromise is likely to survive and be enacted, several groups have announced concerns about one or more portions of the compromise. Foremost among these are business groups opposing the 4% assessment on current premiums (which the compromise permits to be passed on to subscribers) and consumer groups who believe the Governor sacrificed too much of the cost contaiment element in the negotiations. Many Republican legislators also continue to oppose the legislation, for a variety of reasons. But whether any of this opposition, in the face of the lukewarm support of proponents, will be sufficient to actually threaten the bill's passage is anyone's guess at this point.
The three groups will now work with the Governor's staff and the Health Care Reform Committee to develop amendment language to implement the compromise. We begin with a drafting session at 9:00am on Monday morning. The Legislative Committee will return to work on the bill on Tuesday, after adjournment of the morning legislative session.
For a more detailed analysis of the compromise, including the concessions made to the hospitals and insurers, see the most recent Maine Medicine Political Pulse.