Anthem health plan draws praise, criticism

Posted Sept. 10, 2013, at 10:34 a.m.

AUGUSTA, Maine — Central Maine Healthcare employees, Anthem Blue Cross and Blue Shield leaders and others spent hours Monday trying to sway the head of the Maine Bureau of Insurance.

Anthem’s plan to move thousands of individual policyholders into a plan that strictly limits their doctors and hospitals is horrible — or great — depending on who was speaking.

“The outcry from the public has been loud and clear,” Paul Dionne, chairman of Central Maine Healthcare’s board of trustees, said. “The public wants to be protected from Anthem and from MaineHealth. In order to serve the public, the [Maine Bureau of Insurance] superintendent must not limit the public’s right to choose.”

“I think that it’s well documented at this point that narrow networks are regaining popularity,” said Colin McHugh, Anthem’s regional vice president for provider engagement and contracting, later in the hearing. “We think that at this point, given the cost pressure and what’s coming with the ACA [Affordable Care Act], that this will be a very attractive set of products.”

At issue is Anthem’s controversial new insurance proposal that would force some current individual policyholders into a network with MaineHealth providers and their affiliates. Under the plan, patients who bought individual policies after March 2010 could no longer use six Maine hospitals, including Central Maine Medical Center in Lewiston, Rumford Hospital, Bridgton Hospital and Parkview Adventist Medical Center in Brunswick, except in the case of an emergency. They also would be prohibited from seeing doctors affiliated with those hospitals.

The state approved a similar Anthem plan for individuals and small groups buying insurance from the upcoming ACA marketplace, or exchange. The federal government still must approve it.

Now Anthem is seeking state approval to move about 9,000 of its 17,000 current individual policyholders to new plans that use that same narrow network. All of the excluded doctors and hospitals are in southern and central Maine. Of those 9,000 policyholders, just over 7,000 live in those areas.

Anthem said fewer than 1,000 of the southern and central Maine policyholders have primary care doctors who would not be in the network.

Maine Bureau of Insurance Superintendent Eric Cioppa held four public comment sessions on this issue in recent weeks, including one in Auburn that drew a crowd of hundreds and lasted for hours.

Monday’s public hearing allowed more public comment, as well as testimony and questions from the two sides — Anthem and Central Maine Healthcare — and their affiliates.

About 80 people showed up for the morning public comment session, about 30 of them bused in by Central Maine Healthcare. Nine people spoke, seven of them affiliated with CMHC.

Anthem’s leaders pointed out that the Lewiston-based hospital group encouraged workers to attend the hearings, sending out a special employee newsletter that warned, “It’s about your job!”

Two consumers also spoke in the morning. Retired Poland dean of students Ray Lafreniere said he has been assured that his health insurance won’t be affected, but he fears a “slippery slope.”

“That once approved, further down the road, the door would be open to then include other grandfathered plans,” he said.

Another consumer, Charlene Brousseau, an Anthem individual policyholder who would be affected, said she could get care in her hometown in Maine, but Anthem’s plan would mean she could only get emergency care when she spends time in Florida.

“It’s scary,” said Brousseau. “Who wants to pay that type of money and, again, not have the coverage that you need? I just don’t get it. As much as I dislike paying the $13,000 or $14,000 that I now pay annually, I will pay it if my coverage would stay the same. ”

Lewiston-Auburn lawmakers said they had reservations about Anthem’s proposal and they also planned to address the superintendent at the hearing. Six of them signed a letter strongly urging Cioppa to consider their concerns.

One of those lawmakers, Rep. Wayne Werts, D-Auburn, said he has been hearing from constituents who are “scared to death.”

“If those people aren’t allowed to keep their docs, keep their hospital, keep their local care, they’re going to have to do a lot of traveling, which they may not be able to do. And they’re going to lose their ability to see their doc, who they may have been with for 20 or 30 years,” Werts said. “It’s just not fair. It’s not consistent with good and best practices.”

Anthem leaders, however, contended Monday that their proposal would not force any policyholder into a narrow network. All consumers would be free to buy insurance elsewhere.

They also said the narrow network is necessary because MaineHealth, the largest health care organization in the state, is providing substantial discounts to Anthem for the additional patients. Those discounts, Anthem leaders said, will allow Anthem to price its policies about 12 percent less than it could have otherwise.

However, that doesn’t mean Anthem will be the cheapest. Rates have been released for plans likely to be sold through the upcoming marketplace, including Anthem’s narrow network plan — the plan similar to the one at issue Monday. There, Anthem’s rates are, in many cases, higher than competitor Maine Community Health Options, which will allow patients to use any doctor or hospital.

Anthem spokesman Chris Dugan said consumers are getting a savings, even if they don’t see it.

“The rates that you’re looking at are lower than they would have been without this discount,” he said.

Cioppa has said he wants to rule on Anthem’s proposal as soon as possible. No date has been set for his decision.

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