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Anthem Blue Cross and Blue Shield of Maine, the states largest private insurer, is suing the state after Maines Superintendent of Insurance denied Anthem a rate increase that would have required Maine residents to pay an additional $12 million in annual premiums for the same level of benefits. Under Anthems proposed increases, the average policyholder would have had to spend more than $13,000 in premium and deductibles, prior to becoming eligible to receive any health benefits under the policy.
After reviewing Anthems annual rate increases for policies sold within the individual health insurance market, Maine rejected the companys proposed rate increase of 18.9%, but allowed the company to break-even in its individual market division and increase rates by just 10.9%. According to court documents obtained by the Wonk Room, Anthem, a subsidiary of Wellpoint Inc., argued that beyond simply breaking-even, the government must guarantee the company a 3% profit:
A 0% risk and profit charge, by definition, builds in no cushion for any of the risk that Anthem BCBS takes on by selling Individual Insurance Products in Maine. In addition, with a 0% risk and profit charge under the Superintendents approved rates, Anthem BCBS will not be able to provide any contribution to the surplus of the Company Anthem BCBS a for-profit Company cannot be required to operate its highly risky Individual Insurance Products essentially as a non-profit company that must offset losses generated by the Individual Insurance Products through its group insurance business in Maine.
There is no requirement that the Superintendent must affirmatively provide for a profit and risk margin in rates at all times and under all circumstances, the state concluded in its brief. Anthem repeatedly asserts throughout its brief, as if to make true, that for individual insurance rates to be adequate they must cover all expenses incurred by the carrier plus affirmatively provide for a reasonable rate of return that results in a contribution to the surplus of the Company. There is simply no requirement that the Superintendent must affirmatively provide for a profit and risk margin in rates at all times and under all circumstances.
Indeed, considering the companys financial strength and profitability, the ample evidence of extreme financial hardship of subscribers, and the companys dominance of the market place (Anthem controls approximately 78% of the market in Maine), the state chose to shield its residents from subsidizing the insurers profits. After all, individual plans represent only about 6.5% of Anthems total revenue from all operations and for the nine years that Anthem has been in operation in Maine, the pre-tax operating gain or profit from its individual line of insurance in the State totaled approximately $17.4 million. For the year that ended December 31, 2007, Anthems total revenue from all operations for the year, was over $1 billion, and its net income was over $100 million.
In its brief, Anthem argued that the Superintendents reliance on the comments of policyholders is improper. None of the witnesses who made sworn or unsworn statements professed to have an actuarial background and/or familiarity with the financial and actuarial analysis reflected in Anthems BCBSs rate filing to determine whether the rates were designed to cover the costs of the products plus allow for a reasonable rate of return, the company concluded.
Health care reform is going to pass.
You far right cons have forgotten something: you lost.
They didn't lose, they got EVERYTHING they wanted... they got the provision where you could set up a living will with ones own doctor killed, they got the public option killed, they got illegals being able to buy their own health insurance killed...
They made CERTAIN this bill will be a failure once it is passed....and made certain, along with some dems like Baucus, that this bill is a guaranteed gift horse handed to the Insurance industry on a silver platter and will eventually bankrupt us imho....especially with the provisions they made Dems take out in negotiations....that would have been measures to reduce the cost of health care.
Care
Anthem Blue Cross and Blue Shield of Maine, the states largest private insurer, is suing the state after Maines Superintendent of Insurance denied Anthem a rate increase that would have required Maine residents to pay an additional $12 million in annual premiums for the same level of benefits. Under Anthems proposed increases, the average policyholder would have had to spend more than $13,000 in premium and deductibles, prior to becoming eligible to receive any health benefits under the policy.
After reviewing Anthems annual rate increases for policies sold within the individual health insurance market, Maine rejected the companys proposed rate increase of 18.9%, but allowed the company to break-even in its individual market division and increase rates by just 10.9%. According to court documents obtained by the Wonk Room, Anthem, a subsidiary of Wellpoint Inc., argued that beyond simply breaking-even, the government must guarantee the company a 3% profit:
A 0% risk and profit charge, by definition, builds in no cushion for any of the risk that Anthem BCBS takes on by selling Individual Insurance Products in Maine. In addition, with a 0% risk and profit charge under the Superintendents approved rates, Anthem BCBS will not be able to provide any contribution to the surplus of the Company Anthem BCBS a for-profit Company cannot be required to operate its highly risky Individual Insurance Products essentially as a non-profit company that must offset losses generated by the Individual Insurance Products through its group insurance business in Maine.
There is no requirement that the Superintendent must affirmatively provide for a profit and risk margin in rates at all times and under all circumstances, the state concluded in its brief. Anthem repeatedly asserts throughout its brief, as if to make true, that for individual insurance rates to be adequate they must cover all expenses incurred by the carrier plus affirmatively provide for a reasonable rate of return that results in a contribution to the surplus of the Company. There is simply no requirement that the Superintendent must affirmatively provide for a profit and risk margin in rates at all times and under all circumstances.
Indeed, considering the companys financial strength and profitability, the ample evidence of extreme financial hardship of subscribers, and the companys dominance of the market place (Anthem controls approximately 78% of the market in Maine), the state chose to shield its residents from subsidizing the insurers profits. After all, individual plans represent only about 6.5% of Anthems total revenue from all operations and for the nine years that Anthem has been in operation in Maine, the pre-tax operating gain or profit from its individual line of insurance in the State totaled approximately $17.4 million. For the year that ended December 31, 2007, Anthems total revenue from all operations for the year, was over $1 billion, and its net income was over $100 million.
In its brief, Anthem argued that the Superintendents reliance on the comments of policyholders is improper. None of the witnesses who made sworn or unsworn statements professed to have an actuarial background and/or familiarity with the financial and actuarial analysis reflected in Anthems BCBSs rate filing to determine whether the rates were designed to cover the costs of the products plus allow for a reasonable rate of return, the company concluded.
these insurance companies want our gvt to GUARANTEE THEM A PROFIT.....????????
Wonk Room » Anthem BCBS Of Maine Proclaims Entitlement To Profits, Demands Government Guarantee 3 Percent Profit
Nevada would get help with its Medicaid bills. The elderly in Florida and New York would receive additional Medicare benefits. And workers in so-called high-risk professions such as firefighting and construction would get a break on a new insurance tax.
Those are provisions that Senate Democrats, including Majority Leader Harry Reid, put in an $829 billion health-care bill to shield constituents from measures intended to pay for the biggest overhaul of the medical system in four decades.
The result is the new policies may be unevenly administered, with some U.S. states getting preferential treatment, a possibility that has given Republican lawmakers ammunition to attack the legislation.
What the hell are you smoking, boy??And the Baucus plan will not accomplish any of that.
Of course we're in the Era of Intentions, where actual outcome or achievement doesn't matter anymore. It's only the thought that counts.
The Baucus plan will not reduce costs, and that is unfortunate. If there wasn't such an anti-change obstuctionist lobby on the right, just maybe a good plan could have been formed. The problem is that neither the right or left in Washington, or in the US for that matter, want to admit that anything they believe could be wrong. So in the end we get a bill that won't accomplish half of what it is intended to.
The idea that nothing is wrong with our current system is laughable at best. Everyone can see that costs will continue to spiral out of control if we don't do something. Now that the right continues to fight this to the end, we will end up with something that isn't much better than what we have, but at least it will be a start. Down the road, hopefully this plan will be tweaked and made much better. If costs still continue out of control, then eventually the entire system will collapse and we'll just have to start over from scratch.
This has been coming for a long time now, and Republicans had every opportunity to address the healthcare issue but never did. The worst thing about all of this is that there are a number of ways to positively change the system that would allow for near universal coverage while reducing costs, and without jeapardizing the quality of care for anyone.
The GOP has put forward many good proposals that would do all those things. The Dems have blocked even discussion of them, and the media have played along.
If the Dems wanted a good health care plan, they could have produced one. They could have passed it without a single Republican vote.
But they didnt. They made war on the GOP and on their own party. They went for the Big Government option, against the wishes of many of their own party members. Whatever they want to believe, the August town hall meetings should have been a wake up call that they were on the wrong track. Instead the Dem leadership did everything they could to deny it, to delegitimize it, and to demonize it.
No, blame for this turkey is squarely with the Democratic Party.