Blue Cross Blue Shield overcomes obstacles of Affordable Care Act

With ongoing litigation surrounding the Affordable Care Act, officials with Blue Cross Blue Shield of Louisiana said the insurance company is playing the long game for its members, despite the act’s “constant uncertainty.”

“The ACA kind of flipped it on its head and changed the way money moved through the system pretty dramatically,” Michael Bertaut, Blue Cross health care economist, said Monday. He said the move created “some winners and some losers” because of it.

The Louisiana health care marketplace started with six providers in 2014 and is now left with only two. Bertaut said participating in the marketplace was much more expensive than economists originally predicted.

“We lost so much money in the individual market because people who hadn’t had insurance in so much time, they were much sicker than people thought they were … They needed the care,” he said. “We were literally saving their life is what we were doing.”

Over time, Blue Cross has stabilized with the marketplace, allowing it to lower members’ premiums as well.

“We’re not for profit,” Bertaut said. “We don’t have to send dividends to shareholders, so we took the money and we lowered rates. Individuals went down between 5-15 percent.”

The new stability may also lead to other providers re-joining the marketplace, he said.

“Now that we’ve done all the work and lost all the money, more carriers want to come back,” Bertaut said.

Bertaut said he believes the ACA is here to stay because the program covers nearly 30 million Americans.

“A human being who’s a judge would have to say, ‘Federal government, you can no longer spend $70-80 billion a year on people’s health care,’ ” he said.

Such a “doomsday” approach is unlikely to unfold, he said.

“It’s easy to caricature folks, but I haven’t found that many people who shut off health insurance to 29 million people and go home and be able to sleep at night,” Bertaut said.

While the company worked through its revenue loss with the advent of the marketplace, it simultaneously created cost-saving programs and policies for its individual and group members.

The company has restructured the way it pays doctors and hospitals through a “quality over quantity” plan, said Blue Cross Director of Strategic Communications Dianne Nodier Eysink.

“They get more for keeping you well than they do treating you for being sick,” she said.

The company also offers a “smart shopping” method for getting prescriptions filled and nearly 400 routine medical procedures. With the programs, members can view prices for medical expenses and then choose the option that best fits their budget.

“It wouldn’t be for heart surgery or brain surgery, but it would be for things that you have time to make a choice,” Bertaut explained.


For more on the state of health insurance in Louisiana, visit straighttalkla.com.

””Affordable Care Act graphic

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