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
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