June 21, 2013

Maine Voices: Backroom deal jeopardizes health care in central, western Maine

Anthem policyholders whose providers don't belong to MaineHealth may no longer be covered.

By DAVID FRUM, JOHN KROGER, LISA RYAN and ALAN VERRILL

When President Obama signed the Affordable Care Act -- the massive overhaul of the nation's health care system -- he pledged that it would give people better access to quality health care, help lower costs, and that it would not force anyone to change their current doctor or hospital.

Apparently Anthem and MaineHealth didn't get the memo.

Anthem -- Maine's largest provider of health insurance -- and MaineHealth -- Maine's largest health provider, with a network that includes Maine Medical Center -- have cooked up a backroom deal that undermines everything the president promised.

Anthem has applied to the state for permission to cancel current health insurance policies and replace them with new plans. Taxpayers will subsidize these plans as part of the ACA health exchange starting in January 2014. However, in our area of Maine, Anthem will only offer a very limited network of providers and hospitals. While we have not been able to confirm the details, we understand this network will be composed only of MaineHealth and its "affiliates."

That means that if you're an Anthem policyholder who lives in central or western Maine -- where nearly all the providers and hospitals belong to a different network, such as Rumford and Bridgton Hospitals -- you may find that you are no longer covered for medical expenses at your local hospital or family physician you've been seeing for years. You will be forced to change providers and hospitals. Patients will end up traveling long distances to find basic medical care.

Less access and fewer choices is exactly the wrong direction from what the Affordable Care Act was supposed to provide. What are Anthem and MaineHealth thinking?

It would be nice to know. But unfortunately, their plan is steeped in secrecy. They've kept the details under wraps and argued that even their application to the state for this change should be a secret.

We filed to intervene in the Maine Bureau of Insurance review by the June 12 deadline, but we still lack basic information necessary for us to prepare for a public hearing on the plan scheduled for June 28.

This lack of transparency by Anthem and MaineHealth forced other health care providers to file Freedom of Access requests to get the details of their scheme.

We want answers to basic questions: Why is this being proposed? What will it cost? How does it help consumers? Or is it just a scheme by MaineHealth to fend off competition and grab a larger share of the health care market, with Anthem going along for the ride? If so, why are they putting profits ahead of people?

From what we do know, Anthem describes this new policy as a "narrow network," but there's nothing "narrow" about it. Statewide, 32 of the state's 38 hospitals are included in the plan. Excluded are the hospitals of Central Maine HealthCare (Central Maine Medical Center in Lewiston, Bridgton and Rumford Hospitals) along with Parkview Adventist Medical Center in Brunswick, York and Mercy Hospitals.

This proposed "narrow network" also is inconsistent in its approach. All hospitals from Waterville north are included, even in towns with two hospitals such as Waterville and Bangor. The "pick and choose" approach in this part of Maine is an obvious direct result of MaineHealth creating its own self-serving network.

The plan is not based on lower costs. Central Maine Healthcare is the lowest-cost system in the state. Bridgton and Rumford (both critical access hospitals, which offer outpatient and inpatient services in rural areas) are the two lowest-cost hospitals in Maine. CMMC in Lewiston is the lowest-cost tertiary hospital. So if lower cost is the goal, why have they all been excluded from the new Anthem plan?

The plan is not based on better quality for health care consumers. CMMC was recognized as the safest hospital in Maine by Consumer Reports last year and received an A from the Leapfrog Group for 2013.

No, the only common thread connecting the hospitals and providers that are excluded from Anthem's plan is that they compete with MaineHealth or their affiliates for patients or have opposed them in the past. Anthem and MaineHealth are trying to manipulate the taxpayer-subsidized health exchange for their own gain -- higher profits and increased share of the market.

Our providers and hospitals oppose Anthem's plan and are asking Maine people for their help. Come to the hearing in Augusta on June 28 to add your voice. Tell the Bureau of Insurance that we need health care coverage that is affordable and accessible for all.

Let's put people before profits.

David Frum is president of Bridgton and Rumford hospitals; John Kroger, M.D., is a family practitioner in Rumford; Lisa Ryan, D.O., is a pediatrician in Bridgton, and Alan Verrill, M.D., is an internist in Bridgton.

 

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