Maine Supreme Court: Anthem's Profit Can Be Limited

[Dave020]

To be a bit more accurate, you'd get a letter stating that your current data plan is going to $45 per month so you can keep the current data plan with the new rate or we are offering you the opportunity to change to a different data plan (downgrade) anywhere between $20-$30 per month and we will accept a simple written request to make that data plan change for you.

 

[Yagents]

When I lived in Florida, the home insurance market crashed and I was stuck on current policy raising rates.

Flood insurance - one carrier, the US Gov't

Car insurance - I'm sure those that have a record of infractions find themselves stuck

Life insurance - stuck if new pre-ex and older age

E&O hit - lucky to keep existing carrier.

Health is no longer "insurance", it's become a defined entitlement benefit under gov't control. If that's the way a majority wants, let's get moving already and call a spade.......... a spade

 

[Crabcake Johnny]

Pre-ex is a non-issue in this real life example as Maine is GI. You have said that Anthem is making money, which is true, they are making money on certain blocks of thier business. Why must 1 block of business subsidize the other?

It doesn't. If Anthem can't make it work in Maine by offering sustainable rates the public is willing to pay, then leave the market.

 

[djs]

Exactly. If Anthem can't charge what they figure the market will bear, then leave, or buy me an Ipad.

Hmm, not sure if Anthem leaving solves the problem. They weren't allowed to charge a fair rate. Where does that leave us? Where is my government subsidized Ipad?

Of course, for the sake of argument, you can substitute anything you want for my Ipad. Same thing holds true, we are no longer buying insurance to transfer the risk of 'what if something happens' to now we are making a payment plan on when something happens.

Dan

 

[Crabcake Johnny]

Although the "also ran" players are either of the market or on their way out, I think we're starting to see that when a bit of hardball is played, the carrier (despite their empty threats) start playing nicer.

In fact, I don't hear any squawking about the MLR legislation from major carriers and in fact the CEO of Aetna praised it recently for holding them more accountable.

Just like in Massachusetts, when the curtain is pulled back exposing all the lies, they all amazingly (carriers and providers) pull together.

Carriers in MA threated to leave. None left. Hospitals said they'd go under. None have. Providers said they'd shut down their practices. Still trying to find an article.

MA had to put carriers and providers in room like two children and say "work it out or you stay in the room." Looks like they're working it out just fine.

Any bets on whether Anthem will stay in Maine? They'll stay.

 

[Norwayguy]

Although the "also ran" players are either of the market or on their way out, I think we're starting to see that when a bit of hardball is played, the carrier (despite their empty threats) start playing nicer.

In fact, I don't hear any squawking about the MLR legislation from major carriers and in fact the CEO of Aetna praised it recently for holding them more accountable.

Just like in Massachusetts, when the curtain is pulled back exposing all the lies, they all amazingly (carriers and providers) pull together.

Carriers in MA threated to leave. None left. Hospitals said they'd go under. None have. Providers said they'd shut down their practices. Still trying to find an article.

MA had to put carriers and providers in room like two children and say "work it out or you stay in the room." Looks like they're working it out just fine.

Any bets on whether Anthem will stay in Maine? They'll stay.

Yeah they will stay and the Group business will subsidize the Individual Block of business.

 

[somarco]

Nothing keeping them from pulling the IFP product line and only offering group health.

 

[Norwayguy]

Nothing keeping them from pulling the IFP product line and only offering group health.

There actually might be something from when Anthem was allowed to take over our Non-Profit BC/BS....But I don't have the foggiest as Health is an almost dead market in Maine.

 

[somarco]

If there is such an agreement, I don't see how they could be forced to offer new business.

If they ceased to issue new policies the existing block would go into a death spiral and eventually go away.

Carriers have done this before.

 

[Crabcake Johnny]

Anthem simply made the wrong move in the wrong environment. In a time when everyone is getting their ass handed to them, they demanded a rate increase that included a 3% profit built in.

As the DOI, lower court and now the state's supreme court all pointed out (nothing like going 0 for 3), no company is guaranteed a profit. Also as the DOI pointed it, the 3% profit was almost in bad taste as Anthem posted record profits the year before and as they also pointed out, are doing quite well in Maine.

Anthem attempted to show they they needed that large of an increase. The DOI was more than happy to research their claims and call "bullshit."

Anthem claimed "cross-subsidization" claimed that their business in other states had to subsidize Maine. The courts review Anthem's financials and found that wasn't the case at all. Hard to win in court when you lie. In fact Maine's individual business contributed to the company's surplus.

They've have gotten away with his 5 years ago, but again, no one has given Anthem the memo.

Anthem is "0 for everything." They lost in CA, they lost in CT, they lost in MA, etc...My advice to Anthem is stop lying to regulators and maybe you'll win one.