June 26, 2013

Critics: Maine health deal hurts patients

A state agency will soon decide whether letting Anthem and MaineHealth be Obamacare partners is a good idea.

By Jessica Hall jhall@pressherald.com
Staff Writer

Auburn resident Brenda Weeks uses a power wheelchair and has four to six doctor's appointments each month to manage her multiple sclerosis. Now a proposed health insurance deal may force the 54-year-old to switch physicians or buy a new policy.

click image to enlarge

In this September 2012 file photo, a patient is wheeled out of Barbara Bush Children's Hospital at Maine Medical Center in Portland. A state agency will soon decide whether letting Anthem and MaineHealth be Obamacare partners is a good idea.

Gregory Rec / Staff Photographer

Her doctors at Central Maine Medical Center in Lewiston would not be part of a health insurance network proposed by Anthem Blue Cross and Blue Shield, the state's largest health insurer, and MaineHealth, the state's largest network of hospitals and care providers. 

A hearing will be held Friday by Maine's Bureau of Insurance on the proposed partnership between Anthem and MaineHealth. The pact includes 32 of the 38 hospitals in the state, but excludes the three hospitals owned by Central Maine HealthCare in Lewiston, along with Parkview Adventist in Brunswick, York Hospital in York and Mercy Hospital in Portland.

Some doctors are upset that they would be excluded from the plan, and some patients fear that they would no longer be able to go to the doctors and hospitals they now use. The proposal appears to run counter to President Obama's pledge that people will be able to keep their doctors and their health plans.

Anthem has sought permission to cancel the existing health insurance policies of individuals and small-group subscribers and replace them with new plans. That has not been approved by the Bureau of Insurance, and Anthem officials have said it is premature to comment on any changes.

The proposed Anthem-MaineHealth plan is one of two plans that will be sold through an insurance exchange under the federal Affordable Care Act. The other plan is proposed by Maine Community Health Options, a nonprofit, co-op insurance program. Both plans need to be reviewed by the Bureau of Insurance by July 31 and approved by federal regulators.

The health insurance exchanges in Maine will target the roughly 260,000 Mainers who have individual or small-group insurance plans and those who are uninsured. Enrollment is expected to begin in October. The plans would take effect Jan. 1.

Anthem approached MaineHealth last fall to create the network, said Colin McHugh, regional vice president of provider engagement and contracting for Anthem.

The plan, which is called a narrow or focused network that includes only certain hospitals, mirrors plans being created throughout the country in anticipation of the Affordable Care Act, said Trish Riley, senior fellow in health policy and politics at the University of Southern Maine's Muskie School of Public Service.

"It's a trend across the country for value-based purchasing to negotiate the best rates possible," Riley said. "It's a business arrangement. They are negotiating lower rates with hospitals that meet certain quality standards."

Anthem's goal was to create the biggest network practical throughout the state, and it still has "high regard for the hospitals that are not part of this plan," McHugh said.

"We created the broadest continuum of care across the broadest territory," he said. "Consumers may forgo access in the network in exchange for price considerations."

The network is still under review by the Bureau of Insurance, so details about pricing and numbers of patients have not been released.

Brenda Weeks said the Anthem-MaineHealth plan, which would require her to travel long distances in a handicapped-accessible van to visit new doctors in the network, appears to contradict Obama's promise that the Affordable Care Act would not require people to switch doctors. Weeks could have the same doctors if she bought coverage through the Maine Community Health Options network.

In an address to the American Medical Association in July 2009, Obama said: "No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away, no matter what."

(Continued on page 2)

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