The Impact of Blue Cross Conversions on Accessibility, Affordability, and the Public Interest

Abstract

For‐profit organization in health care delivery has been a major public policy issue least since at least the 1980s, driven by the growth of for‐profit hospital chains and a wave of conversions by nonprofit hospitals. As significant as these events have been, however, they pale in comparison with the potential impact of conversions by Blue Cross and/or Blue Shield plans (which we refer to generically as Blue Cross, abbreviated BC). Because Blue Cross plans are the largest health insurer in almost every state (or substate region where they operate), these conversions could remake the corporate landscape of health care finance. Although BC plans no longer hold the overwhelming market share they enjoyed 50 years ago (when they commanded more than two‐thirds of the commercial market; see Blackstone and Fuhr 1998), their share still is considerable. Blue Cross controls at least half the individual market in 33 states and more than a third of the group market in 29 states (Chollet, Kirk, and Chow 2000; McCann 2003).