Maine’s insurance superintendent has granted Anthem Blue Cross and Blue Shield a 5.2 percent average increase in premiums for its individual health insurance customers, starting this summer. The company had requested a 9.7 percent increase.

The final ruling Wednesday means Anthem’s 11,000 individual policy subscribers will pay nearly $3 million more in premiums next year, instead of about $6 million more.

Anthem, the state’s largest health insurance company, has appealed similar rate limits in the past two years. The company is reviewing the latest decision, a spokesman said.

It may be the last time Maine’s Bureau of Insurance gets to review and limit such a rate increase.

Republican-backed health insurance reforms that were signed into law by Gov. Paul LePage this week will let insurance companies avoid state reviews if rate increases are less than 10 percent a year and they are using at least 80 percent of the premiums to pay claims.

The law, intended to inject more competition into the markets for individual and small-group health insurance, will bring Maine closer in line with new federal standards for rate reviews, said Lance Dutson, spokesman for House Speaker Robert Nutting, R-Oakland. The insurance commissioner still will have adequate oversight to prevent excessive rate hikes, he said.

The solution to rising rates is competition to eliminate “this Anthem monopoly,” Dutson said. “Obviously, it’s not working for anybody.”

But critics say the latest rate decision shows that the new law will make insurance more expensive.

Had the state law been in effect months ago, Anthem would have been able to impose the $6 million increase without seeking state permission, said Joe Ditre, executive director of Consumers for Affordable Health Care.

While Anthem pays out 88 percent of its individual policy premiums in claims, it generates millions of dollars in profits from excessive rates and high deductibles, he said.

“The Anthem ratepayers would have had to pay an additional $3 million in premiums for nothing, for profit for the company,” Ditre said. “All (Anthem and other companies) have to do from here on out is request less than 10 percent and avoid rate reviews.”

Although Anthem’s requested increase averaged 9.7 percent, prices for some individual policies would have increased more than 10 percent. The double-digit rate hikes could have triggered limited reviews under the new law, state officials said.

Dutson, the Republican spokesman, said he doesn’t agree that Anthem is raking in cash from individual coverage. “Runaway profitability by insurance companies isn’t something we’re plagued by here,” he said.

Anthem made $15 million in total profits on its individual policies over the past 10 years, according to the insurance superintendent’s decision. But it lost $1.5 million on individual insurance over the past six years, as younger, healthier customers dropped the increasingly expensive coverage.

When Anthem’s group insurance business is included, the company has been much more profitable, generating a total of $184.7 million in dividends for its corporate parent over the past four years, the decision says.

Anthem spokesman Chris Dugan said the individual market used to earn consistent profits, but has become more costly and unpredictable as younger, healthier people have dropped coverage and left older, sicker patients to cover the costs.

The shrinking pool of patients, and rising health care costs, have driven premiums up especially quickly in Maine’s individual market, Dugan said.

Anthem appealed rate decisions by Maine’s insurance superintendent in the past two years, but failed to overturn the rulings in court. Dugan said the company is reviewing the latest decision.

While the rate decision could have been worse for policyholders, a 5.2 percent increase starting in July will be painful, said Susan Gold, who owns a small business in Biddeford.

Like many self-employed people, Gold and her husband buy health insurance in the individual market. They already pay $900 a month for the coverage, and each has a $3,000 deductible.

“That’s over $16,000, as a couple, that we have to pay out of pocket before we get any insurance coverage,” she said. “Five percent is better than 10 percent, that’s the only good thing I can say. … At least the commission listened to us, but with every increase it decreases (our ability) to invest in the company.”

Gold said the new law — and insurers’ ability to avoid future rate reviews — will be good for companies like Anthem, and further hurt small business owners.

The new law may increase competition, but it won’t get younger and healthier people to buy health insurance and share the cost, she said.

“As a result of this law and the increases, my husband and I are seriously thinking of moving our company and ourselves to Vermont, because they have approved a single-payer health insurance system,” she said.

Anne Head, commissioner of the Department of Professional and Financial Regulation, said Maine’s new law is intended to reduce the upward pressure on insurance premiums so big increases, and annual state reviews, won’t be necessary.

Whether Maine’s insurance superintendent reviews future rate increases or not, the latest ruling is the last for the current superintendent, Mila Kofman.

Kofman, who has taken a hard line on Anthem’s rate increases in the last couple of years, announced Monday that she is resigning effective June 1. She cited philosophical differences with the LePage administration over health reform policies.

Staff Writer John Richardson can be contacted at 791-6324 or at:

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