The Dirigo Health board of directors voted Tuesday to charge the greatest amount possible – $43.7 million – to private insurance companies and the self-insured to keep the state’s subsidized DirigoChoice insurance plan going next year and to expand Medicaid.

The board said a smaller amount wouldn’t appease opponents of the plan. That decision is expected to trigger a lawsuit from insurance companies that oppose the size of the fee.

It was a victory, however, for advocacy groups like Consumers for Affordable Health Care and Maine Equal Justice, which argued against a lower figure proposed by the agency that runs Dirigo Health. And, ultimately, four of the five Dirigo board members said voting for the highest amount was worth the risk to insure more people in Maine.

“If somebody wants to sue us, let them sue us,” said Carl Leinonen, formerly head of the Maine State Employees Union and a member of the Dirigo board. “If they’re going to sue us over 5 cents or 50 cents, I’d rather go for 50 cents,” and insure more people, he said.

Dana Connors, president of the Maine State Chamber of Commerce, was the lone board member to vote against the higher amount, saying he couldn’t support using the money to expand Medicaid, or MaineCare as it is called.

“It isn’t the place, time or the vehicle to expand MaineCare,” Connors said, adding it was not what people understood the Dirigo program to be about.

Trish Riley of the governor’s Office of Health Policy and Finance, working with the Dirigo Health agency, had proposed earlier this month to only go for $31 million, in hopes of appeasing opponents and decreasing the amount of the fee that is expected to be passed along to consumers in the form of higher insurance premiums.

The fee, also known as the savings offset payment, is supposed to recoup healthcare savings brought about by Dirigo Health initiatives, including voluntary caps on hospital profits and spending and reduction in bad debt and charity care. The state’s Bureau of Insurance set the maximum amount of those savings at $43.7 million last month.

If only $31 million was assessed, Riley said, the agency could add just 2,400 new members to the state subsidized DirigoChoice insurance plan, bringing total reenrollment to 10,000 by the end of 2006. The rest of the money will pay for an expansion of Medicaid to 10,000 parents at 200 percent of poverty – or $38,700 for a family of four. Based on those calculations, 3,000 individuals and sole proprietors already on a waiting list to get into DirigoChoice would have been slowly added to the program.

“I can’t bear to see people on that waiting list,” said Mary Henderson of Maine Equal Justice, who proposed the resolution that brought the amount to $43.7 million.

Tuesday’s decision not only is expected to trigger a lawsuit, but will raise the political stakes surrounding Dirigo Health, which Gov. John Baldacci is using as one of the centerpieces to his re-election campaign.

Sen. Peter Mills, one of the Republicans in the governor’s race, called on the administration Monday to cut off enrollment in DirigoChoice calling it a “failed” experiment.

He also questioned the wisdom of expanding Medicaid and using the savings offset payment to fund it.

“A family of four that makes $38,700 is entitled to receive “gold card” coverage – nearly for free – under the new Medicaid expansion. If they make just a few dollar more….they are left entirely on their own to find health insurance in the competitive market with no subsidy at all, and they must pay the tax to support those below the cutoff line,” Mills said.

Rebecca Wyke, the governor’s finance commissioner who sits as a non-voting member on the Dirigo board, defended the Medicaid expansion Tuesday, saying it was the cheapest way to cover the uninsured because the federal government matches state expenditures 2-to-1 under Medicaid.

“It’s $58 and 33 cents a month or $700 a year,” to insure each of those 10,000 people, Wyke said. “I do think it’s a good use of state funds.”