Thursday, April 24, 2014
By JESSICA HALL and JOE LAWLOR Staff Writers
Anthem Blue Cross and Blue Shield on Tuesday filed a list of doctors and hospitals that would be part of the health insurance plan it is proposing to be available in the state of Maine under the federal Affordable Care Act.
In this September 2012 file photo, a patient is wheeled out of Barbara Bush Children's Hospital at Maine Medical Center in Portland. Maine Democrats in the Legislature continued their push Wednesday for an expansion of publicly funded health insurance for low-income Mainers and moved to link the expansion with Gov. Paul LePage's plan to pay hospitals about $484 million in outstanding Medicaid reimbursements.
Gregory Rec/Staff Photographer
The move follows a lawsuit filed last week seeking more information on Anthem's proposal. Anthem, the state's largest health insurer, is partnering with MaineHealth, the state's largest hospital network, to offer the plan.
The Anthem-MaineHealth plan, as well as one offered by a nonprofit organization, Maine Community Health Options, are the only two submitted so far proposing to offer insurance on Maine's health exchange under the Affordable Care Act, which goes into full effect in January. The exchanges, insurance marketplaces being created in every state, aim to offer consumers and small businesses more competitive rates by encouraging competition.
Central Maine Healthcare Corp., parent company of Central Maine Medical Center and other hospitals, filed the lawsuit late last week, calling the Anthem-MaineHealth plan a "back-room deal," and seeking to have more details made public.
Central Maine and some other hospitals that compete against MaineHealth are not included in the proposal.
Central Maine Healthcare has said Anthem's plan could require some customers who sign up for it to change doctors or hospitals. Whether that is true is unclear.
Federal regulators will determine which plans will be offered through the Maine exchange, based on recommendations by the state Bureau of Insurance.
Central Maine Healthcare's lawsuit was filed in Kennebec County Superior Court against Eric Cioppa, the superintendent of the Bureau of Insurance, and the Maine Department of Professional and Financial Regulation.
Cioppa on Monday released a list of the doctors and hospitals the plan would include. Anthem filed an updated list of providers with the bureau and released it to the public Tuesday, according to bureau spokesman Doug Dunbar.
Mitchell Stein, public policy director for Consumers for Affordable Health Care, a supporter of the Affordable Care Act, said details of the Anthem proposal are still unknown, and Anthem could end up offering multiple options. Whether Maine residents would be limited in their choice of doctors and hospitals is unclear.
"It's all a big question mark," Stein said.
Stein said the costs of the insurance plans on the exchange will be regulated, much as customer rates for public utilities are regulated. While Mainers purchasing insurance on the exchange may have fewer options compared to other states, the costs are likely to be similar, he said.
"There's still concerns, but those concerns are softened by the regulations in play," Stein said.
Sara Gagne-Holmes, executive director of Maine Equal Justice Partners, a health care advocacy group, said Maine Community Health Options is likely to charge about the same for its insurance plans as Anthem does.
"We don't know yet because their rates haven't been made public, but the plans will probably be comparable," Gagne-Holmes said.
Gagne-Holmes said that Central Maine Healthcare could also partner with an insurance company and offer its own plan on the exchange in 2015.
"There's nothing that would stop Central Maine from offering a product," she said. "The federal government wants the exchanges to be robust, and so they would welcome new competition to the exchanges."
But Chuck Gill, a spokesman for Central Maine Healthcare, said other health insurers have not opted to participate in the exchange, so the company can't offer its own plan.
A public hearing will be held June 28 on the hospitals and providers included in Anthem's plan, but it will not focus on the rates the plan would charge.
A final decision on which plans will be approved will be made by the U.S. Department of Health and Human Services after a recommendation from the Bureau of Insurance, due by July 31.
Dunbar said it's standard for insurance companies filing new products to assert that portions of the filing are confidential. If another party requests that those portions be made public, the bureau has a formal process under which other parties can request that confidential material be made public.
Jessica Hall can be contacted at 791-6316 or at: