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Critics Blast Anthem on Health Plan Insurer Steadfast in Support of DirigoChoice Program

Posted on: Wednesday, 8 February 2006, 15:00 CST

By MEG HASKELL; OF THE NEWS STAFF

AUGUSTA - Maine's largest health insurance company took it on the chin Tuesday at a public hearing that underscored concerns about its support for a major state health initiative. But Anthem Blue Cross and Blue Shield of Maine said it remains committed to the success of the state's DirigoChoice health insurance program and will continue its efforts to increase enrollments.

Testifying enthusiastically in favor of a bill that would make it easier for the Dirigo Health Agency to administer DirigoChoice itself, passionate consumers and health care advocates characterized Anthem - and the for-profit insurance industry in general - as a "fox in the henhouse,""a three-headed monster,""a dragon, a bear, a lion" and "no pussycat," among other things. Anthem, a subsidiary of corporate insurance giant Wellpoint, administers the controversial year-old DirigoChoice plan, which provides members with income-based discounts and rebates on out-of-pocket costs.

Anthem's contract with the state expires Dec. 31. Enrollment stands at about 9,270 participants, mostly individuals and sole- proprietors rather than the small-business employees the state had hoped to attract.

Members of the Maine People's Alliance on Tuesday recounted personal and anecdotal experiences of receiving inaccurate or confusing information about DirigoChoice from insurance agents throughout the state who are designated and trained by Anthem to sell the product.

Consumers testified that they were discouraged from purchasing DirigoChoice and often directed instead to one of Anthem's high- deductible insurance plans. Some said agents spoke disparagingly of the plan or told them no subsidies were available, or that the plan was financially unstable and "a political football." One consumer said she was told to send sensitive personal financial documents to the agent by fax.

"We question whether Anthem really wants the DirigoChoice insurance product to succeed," MPA member Jenny Rottman said at a press conference before the hearing. "We believe that Anthem may have bid on the DirigoChoice contract with the specific goal of undermining its success by discouraging enrollment through the efforts of Anthem [agents]. We believe Anthem may be the 'fox in the henhouse' of DirigoChoice."

State officials also spoke in favor of LD 1845, which would allow the Dirigo Health Agency to break off contract negotiations with Anthem and proceed with developing an organization to manage DirigoChoice, free of legislative participation. Current law requires that such an organization be created only in the event that no insurer makes a reasonable bid for the annual contract, and then only with direct legislative oversight and approval.

The bill, co-sponsored by Rep. Mark Bryant, D-Windham, and his brother, Sen. Bruce Bryant, D-Dixfield, also would make it possible for the Dirigo Health Agency to begin seeking proposals from insurers interested in managing the 2007 program as early as this summer instead of waiting until the end of the Anthem contract term. A proposed amendment allows for an expanded network of insurance agents to sell DirigoChoice, instead of being limited to Anthem's hand-picked agents.

Sara Gagne-Holmes of the governor's Office of Health Policy and Finance told members of the Legislature's Insurance and Financial Affairs Committee that "the Dirigo health program must offer continuity of coverage, regardless of what happens contractually between Anthem and the agency. LD 1845 provides this security for current and future DirigoChoice members and reiterates that Maine is committed to offering comprehensive health care coverage to the uninsured and the underinsured." The bill, she said, would give the Dirigo Health Agency the flexibility it needs to operate responsively.

Dr. Robert McAfee, chairman of the Dirigo Health Agency board, reminded committee members that DirigoChoice insurance policies are issued for one year, and that Anthem's contractual obligation to manage the plan is over in December.

"We do not wish to find ourselves next December with no bidders ... or a bid we find unacceptable and no other choice. That would leave us unable to continue coverage to current members on January 1, 2007," he said. McAfee said the process of developing alternatives must begin soon, in the event that the relationship with Anthem falls apart.

During a break, McAfee said that because Anthem and other insurers in Maine recently sued the Dirigo Health Agency over a requirement that it pay more than $43 million into the agency this year, the relationship between private insurers and the agency may be "too polarized" to allow for the kind of public-private partnership originally envisioned by the Dirigo designers. The so- called savings offset payment reflects the amount of savings Dirigo health reform initiatives have achieved for the health care system over the past year, according to a review conducted by the state's insurance superintendent.

McAfee said he believes it's possible Anthem has deliberately undermined the DirigoChoice plan by limiting marketing and not adequately training its agents.

Anthem spokeswoman Katie Fullam Harris said the company has spent a great deal of time and energy working with its agents. DirigoChoice has been profitable for Anthem, she said, and the company will continue to promote and sell the plan. Harris spoke against passage of LD 1845, saying it would grant the Dirigo Health Agency too much authority to develop an insurance company without direct oversight of the Legislature.

Other insurers, including self-insured organizations such as MaineHealth and the Maine Automobile Dealers Association, also opposed the plan, arguing that the state hasn't the know-how or financial resources to run an insurance company. The Maine Hospital Association and Maine Medical Association also spoke in opposition.

Democrats and Republicans on the insurance committee asked many questions of Tuesday's speakers and requested more information for the work session scheduled for 1 p.m. Thursday in Room 437 of the State House.

Source: Bangor Daily News

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