Court: Insurers' profits irrelevant in rate hike approvals

In a case with potential national implications, Maine's highest court unanimously ruled that state regulators were justified to deny Anthem Health Plans of Maine's proposed rate hike for individual health plans.

The Maine Supreme Judicial Court in its 7-0 ruling found that Insurance Superintendent Mila Kofman "properly balanced the competing interests" when she reduced Anthem's 9.7 percent proposed rate hike to 5.2 percent, Kaiser Health News reported.

Anthem, which sought a 3 percent profit margin, claimed the superintendent's decision, which amounted to only a 1 percent profit margin, violated state law and the U.S. Constitution by depriving the company of a "fair and reasonable return," according to Bangor Daily News.  

Maine law stipulates that premium increases can't be excessive, inadequate or unfairly discriminatory, but the court said the law "is devoid of any language suggesting that the Superintendent must consider an insurer's profit in approving rates for individual health insurance products," CNBC reported.

In response to the ruling, Wellpoint, Anthem's parent company, said the company hasn't decided what it will do next. "We stand by our position that filed rates need to both cover the medical costs for our members and allow for an adequate risk margin to cover unanticipated costs," spokeswoman Kristin Binns told Kaiser Health News.

To learn more:
- read the Maine court ruling (.pdf)
- read the Kaiser Health News article
- see the Bangor Daily News article
- check out the CNBC article

Suggested Articles

Provider groups and health systems are clamoring for HHS to provide direct assistance to cash-strapped hospitals now.

Kaiser Permanente is offering its members free access to Livongo's mental health app myStrength to help address increased stress and anxiety.

Zocdoc has added telehealth appointments to its platform in response to the spike in demand for virtual care.