Health Insurance Failure

Posted Jan. 11, 2010, at 5:37 p.m.

As lawmakers in Washington continue work on a health care overhaul bill, the dire need for insurance reform was crystallized in Maine last week when Anthem Blue Cross and Blue Shield filed a request for a 23 percent rate increase for some of its policies.

A company spokesman said the increases for two individual coverage plans were needed because of the increasing demand for medical services, technology and medication. The point of insurance is to guarantee that people have access to these services. But, when insurance costs increase much faster than wages, people will drop their insurance, put off medical care and, in many cases, their health will deteriorate. Some will be driven into bankruptcy by their medical bills.

At the same time, the cost of providing insurance rises as fewer — often less healthy — people remain in the pool. This prompts insurance companies to further raise their rates and the spiral continues.

These are the overriding problems Congress must fix.

In August, Anthem requested an 18.5 percent increase for the same plans. The superintendent of insurance reduced that to 10.9 percent. Superintendent Mila Koffman also denied the company’s contention that it needed a 3 percent profit margin. Anthem appealed the denial to the Superior Court, where it is pending.

Anthem spokesman Christopher Dugan said the new 22.9 percent increase is needed because 2009 figures show that for every dollar it received in premiums for its nongroup 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 reviewing the earlier request, the Attorney General’s Office noted that Anthem could use the profit it makes in other insurance lines to cover the individual policies. Anthem, of course, should be able to earn a profit. But as other industries have learned, especially in recent years, there are ways to do this other than simply raising prices.

Further, profits across all the company’s product lines have been plenty healthy. Those profits have fluctuated from 5 to 9 percent since 2004, according to the Attorney General’s Office. From 2006 to 2008, Anthem’s Maine operation paid nearly $152 million in dividends to WellPoint, its parent company, according to the same document.

While it is easy to be outraged by Anthem proposing a 40 percent rate increase within a matter of months, the company faces real difficulties in the individual insurance market.

Simply passing that problem to already stretched policy holders, however, is hardly a solution.

Both ends of the problem need to be addressed in health care reform that both better regulates the insurance market and reduces medical costs.

http://bangordailynews.com/2010/01/11/opinion/health-insurance-failure/ printed on July 31, 2014