Friday, April 25, 2014
By Eric Russell firstname.lastname@example.org
PORTLAND – Richard Olesen of South Portland, a policyholder with Anthem Blue Cross and Blue Shield, likes his current health insurance plan because it allows him to choose out-of-network specialists, an option he has taken advantage of in getting treatment for cancer.
"In-network doctors cannot always provide the care I need," he said.
But Olesen, 65, doesn't know whether that will change when he is moved off his wife's insurance policy soon and has to purchase an individual plan. This fall additional provisions of the federal Affordable Care Act go into effect, including the launch of statewide insurance exchanges or marketplaces where consumers can shop for the plan that best suits them.
Anthem, already the biggest insurance provider in the state by far, is likely to be the biggest player in the new exchange. However, the company announced recently that it is changing its options for individual health plans.
Essentially, Anthem wants to discontinue its current plans and offer its 17,500 individual customers -- and possibly many more individuals who currently are uninsured -- other options. About half of customers will be grandfathered in, meaning their plans will not change. The other half will not.
Olesen doesn't know what category he falls into. And even if he is grandfathered, he's worried that he will no longer be able to choose out-of-network doctors.
That's why he showed up to speak Thursday during the first of four public information sessions on upcoming changes to health insurance as a part of the federal Affordable Care Act.
Maine Bureau of Insurance Superintendent Eric Cioppa, who led the session and was joined by other state officials, said the goal is to provide the public with as much information as possible about the looming changes and to hear questions from the public that state officials haven't thought of already.
But Cioppa also wanted to hear about the concerns of Anthem customers.
The Bureau of Insurance is scheduled to decide after a Sept. 9 hearing in Augusta whether the insurance provider can move its customers off their current plans and into the proposed network.
Olesen wasn't the only one worried about Anthem's intentions.
Anne Patenaude, an Anthem policyholder and also a patient advocate, said she believes Anthem is misadvising policyholders about the Affordable Care Act. She said the company's policies appear to conflict with the federal law and with statements made by President Obama that people who like their doctor can keep their doctor and people who like their health plan can keep their health plan.
Worse yet, Patenaude said, the changes proposed by Anthem could result in higher premiums.
"We have no guarantees," she said.
Anthem officials have said that rates have been steadily increasing for years, but the new exchange should slow that trend.
Jud Knox, president and CEO of York Hospital, chastised Cioppa for giving approval to Anthem's plans to partner with MaineHealth on the exchange, a merger that shuts out six hospitals not included in the plan.
"Perhaps you are not close enough to patients and families to understand the consequences of your actions," he said.
Cioppa is likely to hear from even more unhappy health care officials on Aug. 29 in Auburn, next door to Central Maine Healthcare in Lewiston, owner of three hospitals shut out of the Anthem deal.
Only a handful of the 60 or so people who attended Thursday's session spoke. The rest were there to listen. Many were human resource professionals who will soon have to implement that latest Affordable Care Act provisions.
The federal health care law, sometimes called Obamacare, passed in March 2010 and a number of provisions went into effect immediately. However, some of the biggest changes -- including the individual mandate and the implementation of state exchanges -- are just now taking hold.
One of the biggest unknowns at this point, Cioppa said, is how federal subsidies are going to be distributed for low-income Mainers who purchase insurance from the exchange. Failure to obtain coverage would incur a penalty.
But Cioppa said that penalty will be small, at least to start.
"We want this to succeed," he said.
Staff Writer Eric Russell can be contacted at 791-6344 or at: