State Needs to Enforce Its Actions Against Blue Cross

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California health insurance regulators now say they are back in pursuit of Anthem Blue Cross as they examine 1,770 patient policies canceled by the insurer that the state says may be illegal.

We think it is about time they did.

This same state agency, the Department of Managed Health Care, fined Anthem Blue Cross $1 million in March 2007 for "routinely rescinding health insurance policies in violation of state law." Sadly, that fine was never collected. Agency officials admitted to The Associated Press that they didn’t even try to enforce the fine because they feared they could be torpedoed in court.

It’s outrageous enough when an insurer cancels policies at its whim, but when a state regulatory system lacks the backbone to enforce its own laws, California might as well turn over the keys to the insurance company.

The department’s director, Cindy Ehnes, said the agency has had success in forcing smaller insurers to reinstate illegally canceled policies and pay fines; essentially, it’s easy to win a fight against a cream puff. But when it comes to Blue Cross, Ehnes says that insurance heavyweight is too powerful to take on, and with so many cases against the insurer, she said, "that could tie us up in court forever." So, the answer is that we let Anthem Blue Cross slide? We don’t think so.

Even more outrageous is that regulators, instead of collecting the fines, tried to negotiate a settlement with the insurer without success. That’s an embarrassment for our state to lower itself that way.

Now, the agency is trying to rebound, with an attempt at fining the insurer as much as $200,000 for each case of a canceled policy, but we wonder: Is the Department of Managed Health Care serious or is this window dressing?

We agree the insurer has a right to contest each case, so why the sudden change of heart from the agency? Could it be from the latest round of nasty publicity?

The Anthem Blue Cross case goes beyond the agency straight to the governor’s office. According to Consumer Watchdog, Anthem Blue Cross is a subsidiary of Arcus Enterprises and their parent company has given more than $256,600 in campaign contributions to Gov. Arnold Schwarzenegger.

Ehnes insists that had nothing to do with her decision to wave the white flag.

"To be able to defend the citizens of this state, I have to be able to win in court," she says. But, first, you have to go to court.

It’s unbelievable to think that our state’s judicial system would back down from a fair fight, win, lose or draw. If a violation has taken place and a fine has been imposed, it is the duty of each state agency involved to follow through with proper enforcement.

Yes, that could lead to court cases, difficult court cases, and many court cases.

It should never matter if the suit is against the insurance company down the street or Anthem Blue Cross. Maybe as the agency now pursues these cases, there will be some wins and perhaps some losses. At the least, pursue the case and do your best to protect the citizens of this state.

Jerry Flanagan, a health advocate for Consumer Watchdog, said the failure to collect is "a fraud on the people of California." That says it all. We could not agree more.

Consumer Watchdog
Consumer Watchdog
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