Anthem, MaineHealth collude to exclude

Maine's superintendent of insurance should be protecting the interests of health care consumers rather than trying to tilt the competitive playing field between hospital systems.

That is exactly what happened Thursday when Eric Cioppa allowed the state's largest health insurer to collude with the state's largest hospital system to exclude competition.

Government regulation of an industry is usually established to preserve competition. In his decision, Cioppa has, inexplicably, done just the opposite.

His decision gives official blessing to a secret deal cooked up between Anthem and MaineHealth, both based in Portland, to offer a new insurance program under the Affordable Care Act.

The program is designed to lock out MaineHealth's competitors in Portland and elsewhere in southern Maine.

That includes Central Maine Health's affiliated hospitals: Central Maine Medical Center, Bridgton Hospital, Rumford Hospital and their physicians. The lock-out also includes Mercy Hospital in Portland, York Hospital in southern Maine and Parkview Adventist Medical Center in Brunswick.

Of the 38 hospitals in Maine, only the six that compete with Maine Med in southern Maine are excluded from the new plan.

And for what purpose?

Central Maine Health's hospitals are more efficient and offer lower costs, while CMMC has better quality-of-care ratings than Maine Med in a variety of areas.

These are the hospitals and physicians consumers have chosen, which is the hallmark of competition: Informed consumers making their own choices, not the two biggest competitors in a market secretly rate-rigging to eliminate competitors.

The goal of the MaineHealth/Anthem plan is to force consumers to switch physicians and hospitals so it can obtain a larger share of the health care market and increase profits.

It is no secret that Maine Med has financial problems, namely a $13.4 million operating loss in the first quarter of this fiscal year.

Some of this is due to mismanagement, like problems with the hospital's new electronic records system and its fouled-up billing system.

But the hospital is also facing the same challenges as all hospitals: lower Medicaid reimbursements, more charity care, reduced volume and bed-stays.

Other hospital systems across the country are dealing with their problems, and there is no reason consumers in western Maine should be forced to help make up for the Portland hospital's financial woes.

In his decision, Cioppa made the bizarre finding that because Eastern Maine Medical Center provides speciality services to all of northern Maine there's no reason people in southern Maine can't travel long distances for those services.

Sure, people in northern Maine do travel, but they will also tell Cioppa that traveling is a hardship and an inconvenience for patients and families that results in additional expense and time lost from work.

There are many more people in southern Maine, so there are more car dealerships, banks, restaurants — and hospitals.

Ominously, the Bureau of Insurance has scheduled a public hearing for September on whether Anthem should be allowed to draw all of its other 17,000 current members under this insurance program.

That suggests thousands more local residents, university employees and state workers will be forced to change doctors, switch hospitals or travel for care.

Maine Med's goal is to cripple other health care systems and become the dominant hospital in southern Maine.

It seeks to impose by fiat what it could not obtain through honest competition: to monopolize health care in southern Maine, particularly for the most profitable health care services.

This is exactly the way the J.D. Rockefeller built Standard Oil, by making secret deals between his oil company and railroads in the 1800s to gradually strangle his competitors.

If allowed to stand, the MaineHealth/Anthem deal will be remembered in much the same way — as a bad bargain for consumers everywhere.

rrhoades@sunjournal.com

The opinions expressed in this column reflect the views of the ownership and the editorial board.

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Comments

CLAIRE GAMACHE's picture

Obamacare

In states where the ACA is being implemented as intended it has brought down the cost of health care, charity care and eventually health insurance premiums by as much as 30%. You can read about Vermont, California and New York and of course there is Massachusetts which has the highest rated health care in the country. In states like Florida Texas and Maine where the state government is trying its best to sabotage the law you will get a mess. That is what is intended and the people of those states will indeed suffer.

Jonathan McKane's picture

That is simply not true.

The ACA has not brought down the price of insurance anywhere! The best thing any states can do is to implement as little of this law as possible.

CLAIRE GAMACHE's picture

5 states

Last week 5 states reported they have set up their exchanges and are offering health insurance and their rates are lower. Of course, it is still early and it is the thing conservatives fear the most so many things can happen from here on but so far at least it is true.

Jonathan McKane's picture

The only way

The only way premiums might be lower for some is with the subsidies. Otherwise, all premiums are higher.

CLAIRE GAMACHE's picture

lower premiums

What the article I read stated, though I would not swear to it, was that the premiums were lower than expected because more younger people signed up than was expected and this lowered the rate . I also remember reading this occurred in Mass. when they first implemented their law. I'm thinking only time will tell. I do know that most of the nay-sayers who predict disaster with this law are the same people who tell us that Social Security and Medicare are the work of the devil so I have to take their dire predictions with a grain of salt.

Jonathan McKane's picture

Massachusetts rates

are now close to the highest in the country.

Social Security and Medicare are running out of money. You need to read a little more deeply.

CLAIRE GAMACHE's picture

Massachusetts

I have no idea what their rates are compared to everyone else but I have been waiting since the beginning of this whole discussion for folks from there to roundly say how much they hate their health care. I'm only hearing the sound of silence. I expect that the health care law will have many problems because it is such a huge undertaking to overhaul our health care system. I view it as a step forward and expect there will be many more steps. Our health care system does not compare favorably with other countries who manage theirs and it is getting worse every year with more and more charity care, fewer people having access and the cost skyrocketing. We need to do something and the opponents of the ACA have nothing to offer in the way of constructive solutions.

Jonathan McKane's picture

There are plenty of ideas -

They are called the free market. The ACA is designed to do little more than destroy the free market.

There is no true way to compare health statistics from other countries as US citizens 1, are obese, 2, smoke, 3 don't exercise, 4, eat junk food 5, take too many drugs - for a start.

CLAIRE GAMACHE's picture

The free market

What do you call our current health care system if it is not the "free market"? Seems to me the country you described is not very healthy. Maybe fixing some of that would be better than blaming people for being sick. Some of us think we can do better and that good health for everyone is more important than profits.

Jim Cyr's picture

Ms. Gamache, when

we are unable to cross state lines to shop for competing insurance rates, does not conclude a "Free Market". Beside "Tort reform" being able to shop every where for insurance rates would definitely lower rates. Big Brother hates competition !

Jonathan McKane's picture

Same old talking points

I guess if you repeat it long enough...

Our healthcare/health insurance market is anything but free.

And why are profits ok for food, shelter and clothing but not for healthcare?

CLAIRE GAMACHE's picture

Social Security and Medicare

Every government function is running out of money at the moment because everything is being defunded by the folks who want to "drown" the federal government. They are proposing an 83 billion dollar cut to the IRS budget . They will run out of money too. That doesn't mean we shouldn't have someone collecting taxes. It just means we have people in office who seek to destroy our government.

CLAIRE GAMACHE's picture

Obamacare?

I have heard nothing out of Augusta regarding implementing Obamacare. Much to the contrary they are doing everything in their power to stifle.it . I believe this is what we are getting as a result.

Jonathan McKane's picture

This situation

Has absolutely nothing to do with the new burdens of ObamaCare. It is because of Maine's restrictive insurance laws and anti-competition laws such as Certificate of Need and Rule 850 that have created this situation.

 's picture

Free market

So much for competitive free market principles. Once Anthem and Maine Med lock down the market with the assistance of the LePage administration, how long do you think it will be before Anthem rates skyrocket? And Maine Med will have no incentive to provide quality care at affordable rates. This has absolutely nothing to do with Obamacare, and everything to do with a conservative administration picking winners and losers at the expense of the general public.

 's picture

Its capitalism at its finest

Once again, capitalists are proven the most afraid of competition and free markets. Your reply is right on the money.

MARK GRAVEL's picture

Obamacare open the door this

Obamacare open the door this unsightly marriage. Moreover, Obamacare mandates you to do business with them – strike two.

Steve  Dosh's picture

Anthem, MaineHealth collude to exclude

Rex? . Friday night • 20:20 hst
i believe you are correct . Try and prove it though
Here in Hawai'i we have had only two ( 2 ) helth care options -- Kaiser ® and BlueCross ® ( VA hospitals , too )
It's disgusting this collusion and monopolistic behavior for all involved . Hurts competiton and fair pricing schemes and degrades service
Other monopolies? a ) Hawaian AIr ® b ) HELCO - HICO electric companies , c ) Hawaiiantelcom d ) various ambulance and transport services ( barges and ocean going ) We have a Wal - Mart ® and a Home Depot ® on this side of the Big Island . Costco ® and Lowe's ® on the other , Kona side , 2 hours away
There is one Dennys ® on the island and an iHop® . Monopolies is what people strive to attain . Take AT&T® and Microsloth - Winblows ® as good examples . North Korea , too ;)
The good news is that your local nurses are trying to unionize ?
Go nurses ! Union all the way . . /s Dr. Dosh and ohana

PAUL ST JEAN's picture

I believe your governor

I believe your governor happens to be a democrat, Steve.
Are you paying attention, Lil?

MARK GRAVEL's picture

Welcome to the healthcare

Welcome to the healthcare mandate; we've only just begun this journey to, where, to the HELL called Obamacare.

Steve  Dosh's picture

Mark ? Wrong • Who is your

Mark ? Wrong • Who is your primary care provider they'ya in Florida ? Obamacare ® only penalizes those of you out there who choose - not - to elect to have a primary care provider . You will pay more .Do you have one Mark ? Yes [ ] No [ ] Who ? Cat got your tongue ? Obamacare ® helps those of the less fortunate on Medicare ® and Medicaid ® or SNAP , WIC , and TANF . It does . That's precisely why it was enacted . It is to help the less fortunate in times of need . Get more educated Mark ? . Freedom isn't free Neither is 1\2 way decent health care http://www.whitehouse.gov/healthreform
Who wants to go back to the ' good 'ole days ' of coat hanger abortions in the back alleys ca. 1 9 5 9 ?
Nobody • That's what the Republicans in TX want , neither moral nor in the majority . . ..
/s Dr. Dosh and ohana , Hawai'i
" You have the right to remain stupid "

MARK GRAVEL's picture

My insurance premiums jumped

My insurance premiums jumped 38% due to Obamacare. When will I stop being given the government shaft under the guise of helping the less fortunate?

After all, I did work long hours away from my family for what I have, for what, to have it taken away. Perhaps it is time for me to jump in the wagon with the others and to start whipping those who remain to pull it.

PAUL ST JEAN's picture

The free riders will soon, if

The free riders will soon, if not already, outnumber those who are pulling the wagon. obamacare will do nothing but exacerbate that situation.

MARK GRAVEL's picture

Precisely why I need to jump

Precisely why I need to jump in the wagon now and reclaim some of my lost tax dollars before it is too late.

Can I have my Obama-phone please; oh, food stamps and healthcare too.

PAUL ST JEAN's picture

From the ever inquisitive

From the ever inquisitive parrot: "Have you ever wondered how Bibles, or any mention of the Bible, are not allowed in schools, but Bibles are handed out to prison inmates? Maybe, just maybe, if they'd been allowed to read the Bibles in school (those who bothered attending), they might not have ended up in the slammer."

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