Maine’s Dirigo Health reform is a microcosm in the current sea of health reform, but a full decade after its enactment the similarities to the Affordable Care Act (ACA) are striking. Both reforms created subsidized, private health insurance, negotiated by an independent entity; both expanded Medicaid and included strategies to improve quality and lower cost; and both met with strong, well-organized conservative opposition. This essay briefly explains the politics surrounding the Dirigo reform and the compromises that allowed Dirigo to continue under two governors and serve over 41,000 people and nearly 1,000 small businesses which can transition to the ACA January 1, 2014. It suggests why Massachusetts met with less resistance in their reform and concludes with lessons learned from Maine.

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