Anthem Health Plans of Maine, Inc. v. Superintendent of Insurance

2011 ME 48, 18 A.3d 824, 2011 Me. LEXIS 48, 2011 WL 1549426
CourtSupreme Judicial Court of Maine
DecidedApril 21, 2011
DocketBCD-10-255
StatusPublished
Cited by24 cases

This text of 2011 ME 48 (Anthem Health Plans of Maine, Inc. v. Superintendent of Insurance) is published on Counsel Stack Legal Research, covering Supreme Judicial Court of Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Anthem Health Plans of Maine, Inc. v. Superintendent of Insurance, 2011 ME 48, 18 A.3d 824, 2011 Me. LEXIS 48, 2011 WL 1549426 (Me. 2011).

Opinions

SAUFLEY, C.J.

[¶ 1] Anthem Health Plans of Maine, Inc., asks us to determine whether the Maine Superintendent of Insurance may establish rates for individual health insurance products pursuant to which the insurer will not make a profit, but will break even. Because (1) the year in which the challenged rates were effective has passed, and new rates have gone into effect, (2) a favorable decision on the merits could not provide Anthem with any effective financial relief, and (3) both federal and state laws are in transition, we determine that the controversy has lost its vitality and that there exists no basis for the Court to address Anthem’s appeal from the decision entered in the Business and Consumer Docket (Humphrey, C.J.), pursuant to M.R. Civ. P. 80C, declining to set aside the Superintendent’s rate setting for 2009. We therefore dismiss the appeal as moot.

I. BACKGROUND

[¶ 2] Anthem Health Plans of Maine, Inc., d/b/a Anthem Blue Cross and Blue Shield, appeals from a judgment affirming a decision of the Superintendent of Insurance (1) determining that Anthem’s proposed average rate increase of 18.5% applicable to its individual health insurance products, which contained a built-in projected profit and risk margin of 3%, was excessive and discriminatory, and (2) indicating that an average 10.9% rate increase containing a 0% projected profit margin would be approved. Anthem contends that, in setting a profit margin at 0%, the Superintendent’s decision eliminated Anthem’s opportunity to earn a “not ... inadequate” or fair and reasonable rate of return, which, according to Anthem, must include a reasonable profit. Accordingly, Anthem maintains that the Superintendent’s decision violates 24-A M.R.S. § 2736 (2010)1 and the United States and Maine Constitutions.

[826]*826[¶ 3] Anthem filed a petition for review of final agency action in the Superior Court pursuant to M.R. Civ. P. 80C and 5 M.R.S. § 11002 (2010), requesting that the Superintendent’s decision be vacated and the case remanded for approval of a rate that would include a 3% profit margin. The case was transferred to the Business and Consumer Docket. The court found no constitutional or statutory infirmity and affirmed the Superintendent’s decision. Anthem timely filed this appeal.2

[¶ 4] While the case was pending, the rates for the next year, 2010, came under consideration by the Superintendent. Anthem was granted a rate increase that includes a 0.5% profit margin. Anthem Blue Cross & Blue Shield 2010 Individual Rate Filing for HealthChoice, HealthChoice Standard and Basic, and Lumenos Consumer Directed Health Plan Products, No. INS-10-1000, Decision and Order (Me. Bur. of Ins. Sept. 2, 2010). That rate went into effect on October 1, 2010.3

II. DISCUSSION

[¶ 5] Because the 2009 rate is no longer in effect, we must address whether the case is moot. “An issue is deemed to be ‘moot’ when there is no ‘real and substantial controversy, admitting of specific relief through a judgment of conclusive character.’” Smith v. Hannaford Bros. Co., 2008 ME 8, ¶ 6, 940 A.2d 1079, 1081 (quoting Lewiston Daily Sun v. Sch. Admin. Dist. No. 43, 1999 ME 143, ¶ 16, 738 A.2d 1239, 1243). “When determining whether a case is moot, we examine ‘whether there remain sufficient practical effects flowing from the resolution of [the] litigation to justify the application of limited judicial resources.’” Id. (quoting Lewiston Daily Sun, 1999 ME 143, ¶ 14, 738 A.2d at 1243).

[¶ 6] Anthem acknowledges that it cannot obtain any financial relief in this case. The rate year is over, and there exists no authority for Anthem to recover higher rates from the subscribers for that year. Nonetheless, Anthem contends that the case is not moot because the Superintendent has not acknowledged that she erred in failing to provide a profit margin. It seeks an essentially advisory opinion from the Court to provide guidance to the Superintendent in the future. Anthem further argues that the controversy remains live because it has challenged the 2010 rates on the same basis, even though the Superintendent allowed a 0.5% profit margin in the 2010 rates.4

[¶ 7] Despite a continuing controversy over the 2010 rates, a decision in this matter involving the 2009 rates would result in no practical effect. The Superintendent has allowed a profit margin, albeit only 0.5%, for the 2010 rate year, thus the direction that Anthem seeks from the [827]*827Court is not necessary for the 2010 rates.5 Moreover, even if we were to find in Anthem’s favor and vacate the Superintendent’s decision, Anthem has no legal authority to retroactively collect any such increases from policyholders. Because a decision in Anthem’s favor would provide it with no effective relief, the case is moot. Except in extraordinary circumstances, “[w]e will not expend limited judicial resources to review the legal correctness of a decision that will no longer affect the parties involved.” Me. Sch. Admin. Dist. No. 37 v. Pineo, 2010 ME 11, ¶ 8, 988 A.2d 987, 991 (holding appeal of mandatory injunction requiring town selectmen to sign warrant to hold election moot after election was held, but case fit within exception to mootness doctrine); see also Me. Civil Liberties Union v. City of So. Portland, 1999 ME 121, ¶¶ 10-11, 734 A.2d 191, 195 (holding appeal from a summary judgment declaring process for consolidation of voting districts for a special election illegal is moot because election was long over and circumstances were not likely to recur).

[¶ 8] Anticipating that barrier to obtaining appellate review, Anthem contends that the Court should nevertheless decide the case because it fits within one of the exceptions to the mootness doctrine. There are three recognized exceptions to the doctrine that may justify addressing the merits of an otherwise moot appeal:

(1) sufficient collateral consequences will result from the determination of the questions presented so as to justify relief;
(2) the appeal contains questions of great public concern that, in the interest of providing future guidance to the bar and the public, we may address; or
(3)the issues are capable of repetition but evade review because of their fleeting or determinate nature.

Smith, 2008 ME 8, ¶ 8, 940 A.2d at 1081.

[¶ 9] Anthem focuses on the second and third exceptions. It asserts that because rates are regularly superseded in the annual rating cycle, the issues presented here are capable of repetition, but will evade review. See 6 C.M.R. 02031 940-2 § 6(D) (2006) (requiring insurers to review rates annually and file rate revisions as appropriate to avoid the necessity of large rate increases). Anthem also contends that the public concern exception applies because the issue of whether individual health insurance rates set by the Superintendent must include a profit significantly affects the insurance market in the State.

[¶ 10] Although we recognize the cyclical nature of ratemaking in this context, we are not convinced that the precise issues presented in this case will recur.

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Bluebook (online)
2011 ME 48, 18 A.3d 824, 2011 Me. LEXIS 48, 2011 WL 1549426, Counsel Stack Legal Research, https://law.counselstack.com/opinion/anthem-health-plans-of-maine-inc-v-superintendent-of-insurance-me-2011.