Politics, particularly in small states, makes for strange bedfellows. The latest effort to derail Maine'sfirst-in-the-nation 2003Dirigo Health Reform initiative bears this out. The president of the State Chamber of Commerce and a former member of the Dirigo Health Board of Directors is now treasurer of a lobbyist-driven political action committee waging a campaign to sap Dirigo Health of its funding.

From its inception, Dirigo Health Reform has been opposed by the Right and conservative think-tanks. Dirigo Health, named after the state's motto "I lead", set out to increase access to all residents while improving the quality of care and reducing the cost of health care across the state. One of the key elements is DirigoChoice, a public/privateinsurance program offering comprehensive health insurance to individuals and small businesses with sliding scale subsidies for memberswith family incomes up to 300% of poverty. DirigoChoice was largely funded by the Savings Offset Payment, which is an assessment on health insurance claims that is directly proportional to health care savings achieved by various Dirigo Health reforms. Despite its strengths, as we have written -- tying access to cost containment -- the OffsetPayment has been one of the most controversial pieces of Dirigo Health Reform.

To get beyond the acrimony surrounding the Savings Offset Payment, and the millions of dollars the state has spent in lawyer's fees protecting the funding, the Legislature this year enacted new funding - increases in taxes on soda, beer and wine, and a 1.8% premium assessment on all paid health insurance claims. Angry that legislators stood up for health care over the objections of industry lobbyists, the state's business lobby and organizations representing restaurants, grocers, and beer and wine distributors formed the PAC "Fed Up With Taxes." The group is circulating a petition to place a question on the November ballotthat would overturn the new funding law. Working to oppose the overrideis a new coalition ofhealth care groups, called Health Coverage of Maine, whichincludes the American Cancer Society, the Maine Medical Association, and AARP. Petitioners need 55,000 signatures and opponents to the override are actively encouraging Mainers not to sign the petitions.

Despite thepolitical environment surrounding Dirigo Health, it has achieved notable success since it was enacted in 2003. A Robert Wood Johnson study of health insurance trends across the US from 2001 to 2005, shows that Maine isstemming the nationwide tide of rising uninsured rates and drops in employer-based coverage. While more Americans lost coverage from 2001 to 2005, the number of Mainers without health insurance dropped, the result of a strong Medicaid program and the state's 2003 Dirigo Health Reform initiative. Additionally, while nationally fewer small businesses offered health insurance through this period, Maine saw an uptick in the number of small employers covering their employees. Massachusetts similarly saw an increase in the percentage of employers offering coverage after its 2006 health care reform law went into effect. Trish Riley, Director of the Governor's Office of Health Policy and Finance and architect of the Dirigo Health reforms, said that the reform effort has helped Maine hold down health care costs while providing coverage to over 28,000 residents since 2005. In fact, the Dirigo Health Agency says the reforms have saved the Maine health care system more than $190 million over the past year.