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Blue Cross Blue Shield Association

From Wikipedia, the free encyclopedia

This article is about American medical insurance companies. For other uses, see Blue Cross (disambiguation).

Blue Cross Blue Shield Association
Founded1929; 95 years ago (1929)
13-5656874[1]
Legal status501(c)(4) public welfare organization[1]
Location
Coordinates41°53′11″N 87°37′26″W / 41.8864516°N 87.6239771°W / 41.8864516; -87.6239771
ProductsHealth insurance PPOs and HMOs
Kim Keck[1]
SubsidiariesHealth Services Foundation
BC and BS Foundation on Health Care
BCBSA Services Inc[1]
Revenue (2014)
$457,383,677[1]
Expenses (2014)$449,635,361[1]
Employees (2014)
1,253[1]
Websitewww.bcbs.com Edit this at Wikidata

Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a United States-based federation with 34 independent and locally-operated BCBSA companies that provide health insurance in the United States to more than 115 million people as of 2022.[2][3]

It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, and Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948. Its headquarters are at 200 E. Randolph Street in Chicago, Illinois.[4]

BCBSA claims to control access to the Blue Cross and Blue Shield trademarks and names across the United States and in more than 170 other countries, which it then licenses to the affiliated companies for specific, exclusive geographic service areas.[5] It has affiliated plans in all 50 states, Washington, D.C., and Puerto Rico, and licensees offering plans in several foreign countries; it also participates in the nationwide health insurance program for employees of the United States federal government.[6]

BCBSA manages communications between its members and the operating policies required to be a licensee of the trademarks. This permits each BCBSA company to offer nationwide insurance coverage through it's BlueCard provider network and claims reimbursement program even though it operates only in its designated service area.[5]

YouTube Encyclopedic

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  • Blue Cross and Blue Shield | Health care system | Heatlh & Medicine | Khan Academy
  • Not Impossible and the Blue Cross and Blue Shield Association Partnership
  • Not Impossible and the Blue Cross and Blue Shield Association Call to Action
  • Take a Walk!- Blue Cross and Blue Shield Association...
  • #14: Kim Keck [CEO of Blue Cross Blue Shield Association] — Mental Health Equity

Transcription

SAL KHAN: I'm here with Dr. Laurence Baker from Stanford Medical School, who specializes in health care policy. And I have just a very basic question. We see these Blue Cross and Blue Shield all of the time. And sometimes they're used together, sometimes they're used differently. And it just seems confusing to me. What are these things, and how are they related to each other? DR. LAURENCE BAKER: So they're related in some really interesting ways. They go way back in time. So Blue Cross and Blue Shield began as separate things. Let's see if I can get this right. Blue Shield was started by doctors who wanted to set up a health care plan to help their patients get coverage. SAL KHAN: Kind of a preventative shield to help things from getting to you. Right. Right. Right. DR. LAURENCE BAKER: Yes. So that was started a long time ago. These both go back, Blue Cross and Blue Shield, to the 1930s, really, they're getting started. Blue Cross was started by the hospitals, separately from Blue Shield originally, and they got together later as a way to help patients get coverage for hospital care. SAL KHAN: And I guess the cross because once you're in the hospital, you might get a little religious. DR. LAURENCE BAKER: Exactly. I mean, I'm not sure that's what they had in mind originally, but-- SAL KHAN: And what about the blue? DR. LAURENCE BAKER: I don't know where the blue comes from. SAL KHAN: Is that just a color that makes people feel good, it's like a health care color? DR. LAURENCE BAKER: I think it must be a health care color. SAL KHAN: Red would be inappropriate. DR. LAURENCE BAKER: Let's go with blue. You're not bleeding with blue. SAL KHAN: Blue is-- you look at the sky. OK. And so what happened? So, I do see these words used together. So these were separate plans. Doctors created the Blue Shields. Hospitals created the Blue Cross. DR. LAURENCE BAKER: And then they grew over time and changed. So they got started in the '30s. They were around through the '40s and the '50s, '60s, '70s, and so a couple things happen along the way that starts to make things confusing a little bit. One is that they're operating in every state, to some extent, independently. So, states regulate health insurance in this country, or have a lot to do with regulating health insurance in this country. And so, every state had its own laws. And as a result, the Blue Cross and the Blue Shield plans in different states grew up in different ways. So what you come down to today is really different plans in every state because of this history of development. As states develop their laws differently, the plans would evolve in the different states. SAL KHAN: I see. So this is just to give myself a kind of a framework of what's happening, is that pre-1920s, early 1930s, there really weren't health care plans. DR. LAURENCE BAKER: Not to speak of. SAL KHAN: The physicians said, hey, we want a way for people to see us without having to-- some way for them to be paying a little bit every month or every year, and that if something were to happen, they could see the doctors. The hospitals kind of had the same model. But they did it differently in every state because the state is the regulatory-- DR. LAURENCE BAKER: The state especially-- well, in the '30s, there weren't a lot of state regulations about health insurance. There wasn't health insurance. SAL KHAN: Right. DR. LAURENCE BAKER: But as states evolved, as the health care system evolved, as the plans evolved, it grew separately in slightly different directions in every state. So that led to the formation really of, you see Blue Cross of Tennessee, or Blue Shield of Florida, or Blue Cross Blue Shield of Michigan. They're all different, because they're all in their own state environment and they've all grown up differently. SAL KHAN: So, normally-- these kind of are brands. We've all heard of them in that way. But normally, a brand means something. It means more quality, or less quality, or some type of spin on-- you know, Apple means fun consumer experience or something like that. But in this case, if I'm hearing you correctly, if there's Blue Cross of California and Blue Cross of Texas, they have nothing to do with each other, or very little to do with each other? DR. LAURENCE BAKER: So they all had their start kind of together in the '30s, and then they've all grown in their own ways. But they've stayed related, and some of them to greater extents than others. And so one of the things that happened along the way was they formed an association. There's now something in the US called the Blue Cross Blue Shield Association, which is a I guess an association of a lot of the plans in different states that allows them to talk to each other, to try to work together. SAL KHAN: And this is an umbrella for all of the Blue Cross and all of the Blue Shields. So that's why we hear them used so frequently together. People say Blue Cross Blue Shield. DR. LAURENCE BAKER: Yeah. So there's two reasons you hear that together. One is the association that tries to work with plans from both groups. The other is that, in some states, over time, the two got together and actually became one health insurance plan. So there are states where the health insurance plan is Blue Cross and Blue Shield of a state. And there are other states where they stayed separate. So, we're here in California, where Blue Shield and Blue Cross have historically stayed as separate plans. But there are some states where they're the same thing. And then you'd hear Blue Cross and Blue Shield. SAL KHAN: So if someone tells you Blue Cross of state x, that just means to you health insurance plan. There's nothing else that you can really take from that. DR. LAURENCE BAKER: So, once upon a time, you may have been able to take more from it. But these days, it's possible for them to vary in quite a few different ways. Some of the Blue Cross and Blue Shield plans, especially the Blue Cross plans, have become for-profit plans. So, historically these were always nonprofit. But in the last-- SAL KHAN: So Blue Cross especially, some of them have gone for-profit. DR. LAURENCE BAKER: Yes. I think, in both cases, but Blue Cross is the one that I pay more attention to. SAL KHAN: Right. DR. LAURENCE BAKER: So they may be for-profit or not-for-profit plans. They may act in similar ways. And they do, because at least the ones in the association, tend to act with some similarity from place to place. SAL KHAN: And just to-- because I've explained this all the time about even-- Khan Academy is a not-for-profit. A not-for-profit is an entity, it can, in theory, charge revenue-- Khan Academy doesn't-- but it could charge revenue. But there's no owner of the organization who can become rich off of it. It's owned by the public. While a for-profit has shareholders, and it can be bought and sold, and it can issue dividends, and all the rest. DR. LAURENCE BAKER: Yeah. So, historically in America, most health plans were not-for-profit entities. They couldn't take money that they earned and give it out to people who might be the owners. They'd have to be reinvested. SAL KHAN: Exactly. DR. LAURENCE BAKER: In fact, even in the early days of Blue Cross and Blue Shield in some states, they were treated as quasi-public entities. SAL KHAN: Right. Right. Right. DR. LAURENCE BAKER: And they've kind of grown away from that a bit more. But there's this history, especially with Blue Cross and Blue Shield, of very not-for-profit, public-spirited entities. When you get to for-profit plans, which we really didn't have in the US in a big way until maybe the last decade or two, where we've seen some conversions. These are situations where the plan can act explicitly as a profit generator for its shareholders, for its owners. SAL KHAN: And some are now publicly traded and they're on the stock exchange. DR. LAURENCE BAKER: They may be publicly traded, yeah. SAL KHAN: And so when we talk about some of them becoming for-profit here, it's that literally-- I don't know, the license to use the name either Blue Cross or Blue Shield, or maybe some of the assets of the former not-for-profit are somehow transferred, or I guess a for-profit buys them. DR. LAURENCE BAKER: So we had a series of these things. We call them conversions. And when the company converted from being a not-for-profit to a for-profit, there were a lot of states in which those conversions, or situations in which they happened, where the public, the government, somebody compelled the for-profit entity in the conversion to create a public good. So there are some foundations that now exist-- SAL KHAN: Oh, I see. DR. LAURENCE BAKER: In the conversion, they allowed a transfer of a not-for-profit to a for-profit, but you had to create something valuable for the public. So some of the things that we see now in states, some of the big foundations that exist in health care, are conversion foundations around the for-profit conversions of Blue Cross and Blue Shield. SAL KHAN: I see. But when we see things like-- I think it's, I always get confused between Blue Cross and Blue Shield-- but I believe Anthem has a kind of a-- Let me see here, Anthem was a Blue-- DR. LAURENCE BAKER: Blue Cross in California. So, Anthem is a company that is a large company that has Blue Cross, I think mostly Blue Cross or all Blue Cross affiliates or entities in different states. I think there are 14 or 15 of them. SAL KHAN: So these are for-profit Blue Crosses if they have Anthem with them. DR. LAURENCE BAKER: I believe that's correct. SAL KHAN: Right. Right. Right. And is there any, I guess in how they operate, from a consumer point of view, any difference between a for-profit Blue Cross or Blue Shield, or is there anything that we can tell? DR. LAURENCE BAKER: So, that's actually a really interesting question. There are people who've gone to look, and they've tried to sometimes find some evidence for differences. There are a few studies out there where people can find some differences. But there's not a lot of evidence that they behave really differently. At the end of the day, they have to compete in the same marketplace for the business of the same companies and the same people. And if they behaved really obviously different, if one was obviously way better than the other, the market would sort out who's going to win this. And the market has allowed both types to exist. So, there are certainly differences in the written charters, and maybe differences in the preferences in the stated ideals of the people who run these organizations. And that might make a difference in some cases. But it's hard when you get it all together, and you really go try to do national data or something to find a big difference between them. SAL KHAN: So the big picture here is, as much as I've looked at health care plans even when were trying to figure out for employees at Khan Academy, which health care plan to choose and which not. And I've stared, oh, what's the difference between Blue Cross and Blue Shield? There's actually very little I can tell just by looking at those brands. I would really have to dig deeper into the actual health care policy. And that's going to be different from state to state, and some will be for-profit, some will be not-profit. Even that's not enough to tell you a general rule of thumb. You really just have to look at the health care plans. DR. LAURENCE BAKER: You have to look at the health care plans. And it's Blue Cross and Blue Shield. But there's other plans out there. There's Kaiser around here. There's Aetna, and Cigna, and other plans. And they can vary from state to state. And even within, you can see variations. So, Blue Cross in California, Blue Shield in California, might offer some different types of choices. So, if you said, I've got a really nice plan from Blue Cross. And I look at another state, and you look at a Blue Cross plan, it might be that you're just looking at a less generous one, where there is another one that you can look at. So, you even have to look within a company at the specifics. SAL KHAN: Definitely when we go from state to state, it would be weird to have brand loyalty to some of these. DR. LAURENCE BAKER: It would. Yeah. You know Blue Cross Blue Shield-- SAL KHAN: Because they're not going to be the same thing. DR. LAURENCE BAKER: They have this history of being public-spirited entities, and some of that persists to this day. So maybe that's something to think about. But in a general sense, there are so many things that they could vary on that you'd want to be very careful with any choice you make. And know that it could really vary across state lines. SAL KHAN: Interesting.

History

Healthcare in the United States
Government health programs
Private health coverage
Health care reform law
State level reform
Municipal health coverage

Blue Cross and Blue Shield developed separately, with Blue Cross providing coverage for hospital services and Blue Shield covering physicians' services.[7]

Blue Cross is a name used by an association of health insurance plans throughout the United States. Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice president of Baylor University's health care facilities in Dallas, Texas.[8] The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally.[8] The American Hospital Association (AHA) adopted the Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960, the AHA commission was superseded by the Blue Cross Association. Blue Cross severed its ties with the AHA in 1972.

Blue Shield was developed by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians.[9][10] In 1939, the first official Blue Shield plan was founded in California. In 1948, the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans.

In the 1960s, the U.S. government chose to partner with Blue Cross and Blue Shield companies to administer Medicare.[10]

In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS).[11]

Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation, but entitled to "special tax benefits"[12] under IRC 833.[13]

In 1994, BCBS changed to allow its licensees to be for-profit corporations.[7] During 2010, Health Care Service Corporation, the parent company of BCBS in Texas, Oklahoma, New Mexico, Montana and Illinois, nearly doubled its income to $1.09 billion in 2010, and began four years of billion-dollar profits.[14] In the final spending bill for FY 2015 after much lobbying since 2010, nonprofit Blue Cross and Blue Shield plans continue to have special tax breaks that were understood to be threatened by the Affordable Care Act of 2010.[15]

Current organization

Blue Cross and Blue Shield insurance companies are licensees, independent of the association and traditionally of each other,[16] offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state. They also act as administrators [17][16] of Medicare in many states or regions of the U.S.

The Blue Cross Blue Shield Federal Employee Program (FEP) is a nationwide option under the Federal Employees Health Benefits Program (FEHB) for U.S. federal government employees and retirees, and has been part of FEHB since FEHB's inception in 1960.[18] FEP enrolls over half of the federal workforce, with over 5 million members, making it the largest insurer of federal employees and the largest single health plan group in the world.[5][18][19][20]

The association is headquartered in the Michigan Plaza complex in the Chicago Loop area of Chicago, Illinois.[21]

Member affiliated companies

Blue Cross Blue Shield of Wyoming in Gillette, Wyoming

Regional member organizations

Single-state and regional member include the following organizations.

Arizona

Blue Cross Blue Shield of Arizona (BCBSAZ) is a non-profit healthcare organization founded in 1939.[24] BCBSAZ partners with non-profit "Discovery Triangle Development Corporation" to launch a Farm Express mobile market (formerly Fresh Express).[25]

Arkansas

Founded in 1948,[26] Arkansas Blue Cross Blue Shield (ABCBS)[27] is an independent licensee of the Blue Cross Blue Shield Association, and the largest healthcare provider in the state.[28] It donated $1.98 million to The Walton College of Business toward founding its Robert L. Shoptaw Master of Healthcare Business Analytics Program.[29] In August 2022, more than 12,000 members of Arkansas Blue Cross were affected by a ransomware attack on a former affiliate, North Highland Company, LLC.[30]

Delaware

Highmark Blue Cross Blue Shield is the state organization for Delaware. [31]

Idaho

Blue Cross of Idaho and Regence BlueShield Idaho[32] are separate companies and compete throughout the state. In 2019, Regence Blue Shield Idaho announced a strategic alliance (not a merger) with Blue Cross North Carolina.[33]

Kansas

Blue Cross and Blue Shield of Kansas (BCBSKS) was founded in 1942 by Sam Bartham,[34] later becoming an independent licensee of the Blue Cross Blue Shield Association.[35]

Louisiana

Blue Cross Blue Shield of Louisiana is a tax-paying non-profit that was founded in 1934 in New Orleans. An independent licensee of the BCBSA, it is a privately held mutual company without shareholders, which is wholly owned by its policyholders.[36]

Minnesota

Blue Cross Blue Shield of Minnesota (BCBSMN) was founded in 1933, with 3,500 employees reported in 2022.[37]

Mississippi

Blue Cross Blue Shield of Mississippi (BCBSMS) was formed as a privately held company in 1954. In 1948, it was converted to a non-profit. In 1973, its name was changed from Mississippi Hospital and Medical Service to Blue Cross & Blue Shield of Mississippi, Inc., which, in 1996, was converted from a non-profit membership corporation to a mutual insurance company, with the name again changed, to Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company.[38] During 2022, BCBS and University of Mississippi Medical Center (UMMC) network entered conflict over who is to blame for an increasing lack of covered care in the state.[39] Media reported that UMMC had paid close to $279,000 for digital advertising, commercials, and billboards to attack BCBS, which, in subsequent months, sued the hospital for defamation.[40]

Nebraska

Blue Cross Blue Shield of Nebraska was founded in 1939.[41] On July 1, 2018, BCBS Nebraska formed GoodLife Partners Inc., a mutual holding company, to conduct its noninsurance businesses. The company retained the Blue Cross brand, converting from mutual ownership to a stock company wholly owned by GoodLife.[42]

New York

Excellus BlueCross BlueShield (Excellus BCBS, or Excellus) is a non-profit health insurance company headquartered in Rochester, New York. It is part of the Blue Cross Blue Shield Association. BCBS is Upstate New York's largest nonprofit health plan.[43]

In 2001, Excellus merged with Univera Healthcare, (formerly North AmeriCare), based in Buffalo, New York. Univera retained its name and is separate from Excellus BCBS.[44][45][46] Excellus was the target of a cyberattack in 2015, in which 10.5 million records were hacked, and cost the company 17.5 million dollars.[47] The company's Blue Cross Blue Shield subsidiaries have been known as:[48]

  • BlueCross BlueShield of Central New York
  • BlueCross BlueShield of the Rochester Area
  • BlueCross BlueShield of Utica-Watertown

North Carolina

By September 2010, BCBS licensee Blue Cross and Blue Shield of North Carolina announced that it would refund $156 million to their policyholders[49] following documented charges: they had been sued and fined for denying due medical treatments to their customers and for underpaying doctors.[50][51] As of 2019 they were overseeing well over half of all payments for medical services in their state.[52] BCBSNC invests in chronic and underlying condition research,[53] telehealth[54] and artificial intelligence (AI) for digital healthcare.[55]

In 2019, Blue Cross and Blue Shield of North Carolina agreed to enter into a partnership with Cambia Health, but cancelled the agreement later that year.[56] Dr. Patrick H. Conway, who had served as CEO from 2017, was scheduled to become CEO of the merged company, replacing retiring Cambia CEO Mark Ganz, but resigned after a DWI arrest in June 2019, putting the merger on hold.[57]

Pennsylvania

Though historically "Blue Cross" was used for hospital coverage while "Blue Shield" was used for medical coverage,[58] today that split only exists for traditional health insurance plans in Pennsylvania. Two independent companies operate in central Pennsylvania, Highmark Blue Shield in Pittsburgh and Capital Blue Cross in Central Pennsylvania. In southeastern Pennsylvania, Independence Blue Cross in Philadelphia has a joint marketing agreement with Highmark Blue Shield in Pittsburgh for their separate hospital and medical plans. However, Independence Blue Cross, like most of its sister Blue Cross Blue Shield companies, cover most of their customers under managed care plans such as HMOs and PPOs which provide hospital and medical care in one policy.

Rhode Island

Blue Cross & Blue Shield of Rhode Island was founded in 1939.[59] The insurer is headquartered in Providence, Rhode Island.

U.S. Virgin Islands

BlueCross BlueShield of the U.S. Virgin Islands is administered by BlueCross BlueShield of Puerto Rico.[60]

Vermont

Blue Cross Blue Shield of Vermont was founded in 1980.[61] In 2022, BCBS Vermont sued Teva Pharmaceuticals over its "years-long scheme to reap excessive profits" from sales of its multiple sclerosis (MS) drug, Copaxone.[62]

Wyoming

Blue Cross Blue Shield of Wyoming (BCBSWY) is a non-profit founded in 1945.[63] In 2022, BCBSWY penned opposition to the Pharmacy benefit managers act enhancements (Wyoming Senate File 0036).[64]

Nonprofit status debate

While only some members retain nonprofit status, the ones that do have been criticized for holding excessive amounts of cash or excessive executive compensation. For instance, the CEO of BCBS Michigan, Daniel Loepp, earned over 19 million USD in 2018, more than the CEO of Ford or Fiat Chrysler during the same year.[65]

In 2014, BC/BS of Illinois (Health Care Service Corporation) was sued over its nonprofit status. The lawsuit was dismissed, with prejudice, and the dismissal ruling was upheld on appeal.[66] Similar suits occurred with similar results in other states such as Oregon.[67]

For-profit conversions

Conversions into for-profit corporations typically results in distribution of some of the assets into a charitable foundation. When Blue Cross of California was converted, it initially had no distribution, but subsequently The California Endowment and California Health Care Foundation were endowed with $3.2 billion.[68] Proceeds ranged from $3.2 billion (California) to $1.5 million (Nevada).[69]: 63 

An exceptional case occurred in the Empire Blue Cross conversion, where the proceeds went to fund wage increases for union workers.[70]

Antitrust settlement

In 2022, the group of 34 companies that make up the BCBS Association settled an antitrust investigation by allowing competition among member companies under non-Blue names while retaining regional exclusivity for regional licenses.[71]

Claim denial controversies

In 2018 Robert Salim was diagnosed with stage 4 throat cancer, however the proton therapy ordered by his doctor was denied by Blue Cross Blue Shield. Salim sued.[72] In July 2022 the United States District Court, Western District of Louisiana ruled that "Because Salim showed that PBT was a nationally accepted standard of care for advanced head and neck cancer in 2018, BCBSLA abused its discretion in finding Salim's PBT treatment was not medically necessary."[73] A Propublica investigation found that Blue Cross and Blue Shield of Louisiana used guidelines from an outside company called AIM Specialty Health to reject appeals for denial, and that this practice was widespread.[72]

See also

References

  1. ^ a b c d e f g "Form 990: Return of Organization Exempt from Income Tax". Blue Cross and Blue Shield Association. Guidestar. December 31, 2014.
  2. ^ "Blue Facts Sheet 2022" Blue Cross Blue Shield Association, BCBS.com.
  3. ^ "Blue Cross Blue Shield Association - Supporting the 36 Independent, Locally Operated Blue Cross and Blue Shield Companies - BCBS.com". bcbs.com. Archived from the original on November 5, 2011. Retrieved November 2, 2011.
  4. ^ The Blues: History of the Blue Cross and Blue Shield System by Robert Cunningham III and Robert M. Cunningham Jr. 1997; page 3. ISBN 9780875802244
  5. ^ a b c "The Blue Cross Blue Shield System | Blue Cross Blue Shield". www.bcbs.com. Retrieved December 11, 2019.
  6. ^ "BCBS® Companies and Licensees | Blue Cross Blue Shield". www.bcbs.com. Retrieved December 11, 2019.
  7. ^ a b Coordinated Issue Paper – Blue Cross Blue Shield/Health Insurance; Life Insurance: Conversion of nonprofit corporations. 4 June 2008) Archived 6 May 2009 at the Wayback Machine
  8. ^ a b Justin Ford Kimball from the Handbook of Texas Online. Retrieved August 31, 2009. [dead link]
  9. ^ "Health Care Service Corporation (HCSC) – Who We Are". www.hcsc.com. Archived from the original on November 8, 2016. Retrieved January 6, 2017.
  10. ^ a b Marc Lichtenstein (n.d.). "Health Insurance From Invention to Innovation: A History of the Blue Cross and Blue Shield Companies". Blue Cross and Blue Shield Association. Archived from the original on May 23, 2014. Retrieved May 23, 2014.
  11. ^ "History of Blue Cross and Blue Shield Association – 1980s". Blue Cross and Blue Shield Association. Archived from the original on September 26, 2009.
  12. ^ "Nonprofit Health Inc.: Overview of issues in the protection of nonprofit assets - Blue Cross: 501(m)". Consumers Union. January 1, 2008. Retrieved December 18, 2014. As of January 1, 1987, the federal government removed the full tax-exempt status of BCBS plans and instead created a special tax class for BCBS organizations, Internal Revenue Code ("I.R.C.") 5833. That I.R.C. category subjected BCBS plans to federal taxation but recognized the unique role BCBS plans play, unlike commercial for-profit insurers, and entitled it to special tax benefits.
  13. ^ 26 USC § 833 – Treatment of Blue Cross and Blue Shield organizations, etc. | Title 26 – Internal Revenue Code | U.S. Code | LII / Legal Information Institute law.cornell.edu. Retrieved on 2013-09-05.
  14. ^ "Blue Cross parent boosts profit in second quarter". Crain's Chicago Business. Crain Communication, Inc. September 3, 2013. Retrieved December 18, 2014.
  15. ^ Pear, Robert (December 14, 2014). "In Final Spending Bill, Salty Food and Belching Cows Are Winners". The New York Times. Retrieved December 18, 2014.
  16. ^ a b Martin Gottlieb (August 2, 1993). "For Nation's Blue Cross Plans, Echoes of the Troubles at Empire". The New York Times. Retrieved September 4, 2022.
  17. ^ NYT quote: Now you have non-medical people, business promoters, coming in and running Blue Crosses.
  18. ^ a b "Blue Cross and Blue Shield's Federal Employee Plan". FEP Blue. Retrieved December 11, 2019.
  19. ^ "Feds Are Flocking to the Same Few Health Care Plans Despite Choices". Government Executive. November 7, 2017. Retrieved December 11, 2019. GAO said since 2000, Blue Cross Blue Shield has become a behemoth in the federal employee insurance market. The company was the largest carrier in 93 percent of counties in 2000, and that proportion grew to 98 percent in 2015. Over that same time period, Blue Cross Blue Shield grew its median county market share from 58 percent to 72 percent.
  20. ^ FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM: Enrollment Remains Concentrated Despite More Plan Offerings, and Effects of Adding Plan Types Are Uncertain. United States Government Accountability Office. 2017. p. 35. BCBSA's large program market share—66 percent of total program enrollment in 2015
  21. ^ "Contact Us". Blue Cross and Blue Shield Association. Archived from the original on January 10, 2007. Retrieved December 23, 2009.
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