anthem blue cross and blue shield - Maine.gov

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Q. Would you please tell the Superintendent what those concerns1are?
A. First, if the ten thousand-plus York Hospital Anthem patients elect 2 to incur the burdens of
travel and expense in order to treat with Goodall Hospital and its 3 providers, or Southern
Maine Medical Center and its providers, or even Maine Medical 4 Center and its providers,
I doubt that those hospitals and their providers have the capacity 5 to accept these patients
and treat them without undue delays. I do not believe that the 6proposed Anthem Plans
have demonstrated how its narrow network will be able to absorb 7 the Anthem members
who have been treating with excluded providers. Even if Anthem 8 could satisfy the
1:2000/PCP:member ratio in the Bureau’s rules, those ratios do9
not tell the whole story
as to capacity and network adequacy. After all, the PCP’s and10
specialists within the
narrow Anthem network do not care for Anthem members exclusively. 11
This issue was a challenge in the state of Massachusetts upon12
their roll out of an
Exchange-like mechanism even when the network had not been 13 narrowed or limited to a
select group of hospitals. By allowing Anthem to narrow its network 14 at a time when an
influx of patients is entering Exchanges for coverage will exacerbate 15 the problem of
primary care access. This sends the wrong message to the patient, 16 and the State of Maine
can do better.
Q. Is there anything else that causes you to be concerned about the 18 adequacy of the Anthem
network?
A. Yes. Many Maine citizens who are currently part of the MaineCare 20 program will soon be
uninsured. According to the U.S. Census Bureau Small Area21
Health Insurance Estimates
(SAHIE) 2010 data, there are an estimated 133,000 uninsured22
Mainers under 65 years of
age. The data show that 114,430 of the 133,000 uninsured live 23in households with
incomes under 400% FPL. These uninsured Mainers will be 24 eligible for subsidies for
insurance coverage via the federal Exchange established under 25the Affordable Care Act.
About two-thirds (or 76,072) of these Maine uninsureds live in 26one of six counties as
follows: Cumberland (21,701), York (15,204), Penobscot (13,305), 27 Kennebec (9,383),
Androscoggin (9,160), and Aroostook (7,319). These are the28
most recent county-level
data. Forty-six thousand of these uninsureds live in Cumberland, 29 York, and
Androscoggin counties. If we assume that even half of these uninsureds were to opt for
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