PORTLAND, Maine — Anthem Blue Cross and Blue Shield of Maine drew fire Thursday from health care reform advocates and a member of the state’s congressional delegation for proposing a rate increase of more than 20 percent for its Luminos and HealthChoice health insurance plans while its appeal in an earlier case seeking a higher operating margin remains unsettled.
Anthem is seeking average 22.9 percent increases for the two individual coverage plans, saying that the increasing demand for medical services, use of new prescription drugs and demand for advanced technologies are driving up the cost of health care at an unprecedented rate.
If approved, the increase would take effect July 1, 2010.
Anthem spokesman Christopher Dugan said the newly filed increase is justified based on 2009 figures showing that for every dollar it received in premiums for its non-group products, it paid out $1.04 in claims, administrative costs — including marketing and other promotional costs — and taxes.
Dugan said Maine’s insurance regulations, which include guaranteed coverage regardless of health status and limitations on how much premium rates can vary for the same plan, tend to drive up the cost of coverage in the individual market. As a result, he said, younger, healthier people drop coverage leaving a pool of high-risk enrollees who use a lot of services.
In addition, Dugan said, the high cost of health care services in Maine compared with other states also increases costs.
While product lines in Anthem’s small-group and large-group market remain profitable, Dugan said, in the individual market “the claims expense outweighs the premiums.”
The request was filed Monday as Anthem awaits a court ruling in an earlier rate case.
Maine Insurance Superintendent Mila Koffman last spring denied Anthem’s proposed 18 percent rate hike for its individual insurance plans. Instead, she approved a revised request for a 10.9 percent increase, which provided for a zero percent profit margin.
Anthem’s Dugan said the company’s appeal seeks to establish a 3 percent margin in that increase. Historically, Maine regulators have permitted an operating margin, he said. No date for the hearing on that case has been set.
Phil Bailey, state director of the advocacy group Maine Change That Works, said it’s “absolutely incredible” that even before the appeal case has been heard in Superior Court, Anthem is seeking a nearly 23 percent increase.
“Have they no shame?” Bailey said.
U.S. Rep. Chellie Pingree, D-1st District, said in a statement that requesting a 23 percent rate increase during a recession is “outrageous and is an example of why we need to pass comprehensive health care reform.”
The new rate increase is being sought “to make sure we’ve got adequate resources going forward,” Dugan said.
BDN writer Meg Haskell and The Associated Press contributed to this report.