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

2012 ME 21, 40 A.3d 380, 2012 WL 621026, 2012 Me. LEXIS 22
CourtSupreme Judicial Court of Maine
DecidedFebruary 28, 2012
StatusPublished
Cited by7 cases

This text of 2012 ME 21 (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, 2012 ME 21, 40 A.3d 380, 2012 WL 621026, 2012 Me. LEXIS 22 (Me. 2012).

Opinion

JABAR, J.

[¶ 1] Anthem Health Plans of Maine, Inc., d/b/a Anthem Blue Cross and Blue Shield (Anthem), appeals from the judgment entered in the Business and Consumer Docket {Humphrey, C.J.) pursuant to M.R. Civ. P. 80C affirming a decision by the Superintendent of Insurance (1) determining that Anthem’s proposed rate increase for its individual health insurance products — an increase of 9.2% that contained a built-in risk and profit margin of 8% for those products — was excessive and unfairly discriminatory; and (2) indicating that an average rate increase of 5.2%, containing a built-in risk and profit margin of 1% for the period from July 1, 2011 through June 80, 2012, would be approved. Anthem contends that the Superintendent’s decision violates 24-A M.R.S. § 2736 (2011) and the United States and Maine Constitutions because the approved rate increase eliminates Anthem’s opportunity to earn a reasonable profit on its line of individual health insurance products in Maine. We disagree and affirm.

I. BACKGROUND

[¶ 2] In this expedited appeal, Anthem appeals from the judgment affirming a decision of the Superintendent of Insurance (Superintendent) regarding the rates approved for the rate period between July 1, 2011, and June 30, 2012.

[¶ 3] The facts are not in dispute. In Maine, the rates for Anthem’s group health insurance products are unregulated and subject to market forces, while rates for Anthem’s individual health insurance products are regulated pursuant to 24-A M.R.S. §§ 2736 to 2736-C (2011). Section 2736(1) provides that “[ejvery insurer shall file for approval by the superintendent every rate, rating formula, classification of risks and every modification of any formula or classification that it proposes to use in connection with individual health insurance policies....”1 The Superintendent is vested with the authority “to determine whether such filing meets the requirements that rates not be excessive, inadequate or unfairly discriminatory.” Id. § 2736(2).2

[IT 4] On January 28, 2011, Anthem filed proposed revised rates for the company’s individual health insurance products— HealthChoice, HealthChoice HDHP, HealthChoice Standard and Basic, HMO Standard and Basic, and Lumenos Consumer Directed Health Plan — to become effective on July 1, 2011. Anthem’s initial rate proposal for its line of individual health plans would have resulted in an average rate increase of 9.7% for nearly 11,000 Anthem policyholders. . Anthem built into its proposed 2011 rates a “3% ... targeted pre-tax profit and risk component ... solely in recognition of the Superintendent’s prior orders.” On February 7, 2011, March 2, 2011, and March 31, 2011, Anthem filed revisions to the initial filing to correct errors and to provide the Superintendent with additional [382]*382data and information. By the time of the hearing, Anthem had modified its proposed average rate increase to 9.2% and included in the various revised submissions a requested risk and profit margin that fluctuated between 2.3% and 2.5%. However, Anthem maintains in this appeal that any approved rate should include at least a 3% risk and profit margin.

[¶ 5] Between March 14 and April 13, 2011, the Superintendent held five public hearings where she admitted into evidence the sworn testimony of public commenters and the submissions of Anthem, the Attorney General, and party-in-interest Consumers for Affordable Health Care (Consumers).

[¶ 6] The Superintendent issued the decision and order that is the subject of this appeal on May 12, 2011. Critical to our analysis, the Superintendent interpreted the statutory mandate of 24-A M.R.S. § 2736(2) as requiring a balancing between a rate that would not threaten the “financial integrity” of insurers and “the legitimate government interests of protecting the viability of the insurance pool, keeping insurance premiums as reasonable as possible, and minimizing adverse selection.”

[¶ 7] In applying her interpretation of the requirement that the rates not be “inadequate,” the Superintendent noted that from 1999 to 2010 Anthem’s individual insurance product lines in Maine resulted in a “pre-tax operating gain ... [of] over $15.5 million and averaged 2.1% of total revenue.” The Superintendent recognized, consistent -with the testimony of Anthem’s representatives, that the profits from Anthem’s line of individual insurance products were integrated into a “consolidated, company-wide surplus [that] is available both to meet all financial obligations of the corporation, including all insurance claims from all lines of business, and to pay shareholder dividends to the parent corporation.” On the basis of her opinion that the adequacy (or inadequacy) of Anthem’s proposed rates should be viewed through the lens of Anthem’s overall corporate health, the Superintendent found that Anthem’s “[p]rofits, including those achieved from Anthem’s individual health insurance business in [Maine],” contributed to a company-wide surplus that “increased from $209,500,000 in 2009 to $229,100,000 in 2010.” As a result of the overall profitability of the company’s health insurance products, including the pre-tax profitability trend of the individual product lines,3 the Superintendent found that between 2007 and 2010 Anthem was able to make dividend payments of over $184 million, including over $20 million in 2010 alone, to its corporate parent.

[¶8] Against the weight of Anthem’s individual product line profitability and Anthem’s company-wide success, the Superintendent cited the sworn testimony of nearly forty Anthem policyholders who indicated that Anthem’s average proposed rate increase would intensify their already difficult individual financial situations and threaten “their corresponding ability (or inability) to stay insured.” In order to protect the public interest in maintaining “affordable individual health insurance rates to the fullest extent possible” and alleviate “the concern that rising rates have caused adverse selection4 in An[383]*383them’s individual insurance business,” the Superintendent ultimately concluded that Anthem’s proposed average rate increase of 9.2%,5 which included a 3% built-in risk and profit margin, was “not inadequate,” but was “excessive and unfairly discriminatory in contravention of section 2736.” As part of her conclusion, the Superintendent specifically identified the problematic dimension of Anthem’s proposed 3% risk and profit margin: “While Anthem’s 3% risk and profit margin in its 2011 rate development might be appropriate under a different evidentiary record, ... it would contribute to making this year’s 9.7% [sic] requested average rate increase excessive.”

[¶ 9] The Superintendent advised in the May 12 decision that she would approve a 5.2% average rate increase with a 1% built-in risk and profit margin. Immediately following that decision, Anthem submitted a revised fifing intended to comply with its terms. The Superintendent issued a subsequent order on May 18, 2011, putting into effect the approved 5.2% rate increase and corresponding 1% built-in risk and profit margin. See 24-A M.R.S. § 2736-B.

[¶ 10] 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 (2011).

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2012 ME 21, 40 A.3d 380, 2012 WL 621026, 2012 Me. LEXIS 22, Counsel Stack Legal Research, https://law.counselstack.com/opinion/anthem-health-plans-of-maine-inc-v-superintendent-of-insurance-me-2012.