(Augusta)  Consumers for Affordable Health Care (CAHC), Maine's largest consumer health organization, applauded the decision rendered on August 29 by Maine Superior Court Chief Justice Thomas Humphrey that upheld the decision made by the Maine Bureau of Insurance (BoI) in the rate review hearing with Anthem.  The Superintendent, the Attorney General, and CAHC were named parties in the lawsuit also. The oral arguments were heard on August 18 at the Superior Court in Portland.  Chief Justice Humphrey's decision affirms the Decision and Order made by Maine BoI on May 18 that reduced Anthem's request by almost $3 million. Anthem, which had requested an average rate increase of 9.7% in the individual market, was granted a rate increase of 5.2% in May by then-BoI Superintendent Mila Kofman.  Anthem has the right to appeal this decision to the Maine Supreme Court. 

The Attorney General's Office represented the Superintendent of Insurance. Joe Ditré, Esq., the executive director of CAHC, and Andrea Irwin, Esq., a staff attorney at CAHC provided legal representation to consumers and nurses in the proceeding.

"The decision rendered by the Maine Superior Court affirms that the rate review process in Maine works for consumers and policyholders," said Ditré.  "Due to the rate review proceedings - and reaffirmed by this decision - Anthem policyholders will save nearly $3 million dollar this year.  That's direct savings because they're paying lower premium rates." 

Under Public Law, Chapter 90, however, insurance companies may be able to preclude themselves from the rate review process if certain thresholds are met. 

"Public Law 90 could be a triple whammy on thousands of Maine insurance consumers. It allows carriers to raise rates beyond prior limits, imposes a new $4 per person per month tax on their health insurance, and in many instances allows individual insurance companies to avoid rate review. If PL 90 had been the law last year, Anthem's individual policyholders would have paid almost $3 million more in rates -- most of it for Anthem's profits. That's just not fair." said Ditré.

While the Affordable Care Act requires rate review hearings if the rate increases sought are greater than 10%, it does preclude Maine or any state from reviewing requests that are less than 10% -- as Anthem did this year with its 9.7% request. What will happen is that Mainer policyholders will lose the opportunity to save millions of dollars as they did here.

 Source: Superintendent of Insurance Decision and Order, May 12, 2011 at pp. 37 - 38

Between 2007-2010, Anthem was able to pay its parent company, Wellpoint, dividends of close to $185 million from its Maine business alone.

  Source: Superintendent of Insurance Decision and Order, May 12, 2011 at p. 39

"If policyholders are wondering why health insurance costs are high, they don't have to look very far. Anthem wanted almost $2 million (of its requested $6 million increase) for profits alone. The Superintendent's decision reduced that request by more than $1 million. At a time when policyholders cannot afford health care, Anthem's demand for 3% (about $2 million) was unconscionable," said Ditré. The Superintendent's decision granted an average rate increase of 5.2% of which one full percentage point (or about $600,000) was for profits.

Please click here for the Superior Court's decision. 

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