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

Abstract

This article surveys the full range of health policy impacts of Blue Cross conversions from nonprofit to for-profit status. It concludes that conversion increases pressures to generate more profit, which may lead to either negative or positive changes in operations. To date, there is little evidence that converted plans have raised rates faster than medical cost trends or have sharply changed medical underwriting policies. Instead, the most visible effect of conversion is more intense efforts to negotiate deeper price discounts with providers. On balance, Blue Cross conversions have so far not caused serious harm to statewide measures of health care affordability and accessibility. Still, because each state and each conversion is different, even if the historical record is clear elsewhere, it is difficult to predict the actual effects in a particular state.