Maine Regulator Gets Tough in Health Care Battleground

Regulator in Maine is leading the fight there against excess profits.

ByABC News
April 2, 2010, 5:56 PM

April 2, 2010— -- There is a showdown taking place between insurance companies trying to raise premiums on hard-hit policy holders and some state officials determined to stop them.

Mila Kofman, the insurance regulator in Maine, one of 29 states with the power to control the price of health insurance, is leading the fight there against excess profits.

Very few of the state regulators who have authority like Kofman's actually use their power.

"Historically, half of them came out of the insurance industry and half will go there when they are done," said Robert Hunter, a former insurance regulator in Texas and director of insurance for the Consumer Federation of America. "They don't want to be too tough on an industry they'll soon be joining."

But Kofman is different. She has no past or present ties to the insurance industry and prior to her appointment as superintendent of insurance for Maine, she was a Georgetown professor specializing in consumer protection.

"We are the super cops on the street," Kofman said. "We have to make sure that private health insurance companies keep their promises. That means staying solvent, but also making sure that the rates are supportable, adequate and that they're not excessive."

As the White House today took the first steps under the new health care reform law to help people with pre-existing conditions get coverage, Kofman was staring down insurance companies on the front lines.

Her biggest battle is with Anthem Blue Cross and Blue Shield, a part of WellPoint, which made a $33 million profit in Maine last year, but lost $2.3 million covering individuals who bought their coverage privately.