Blue Shield

In filings with state regulators, Blue Shield is seeking an average rate increase of 12% for more than 300,000 customers. Consumer advocates say the firm should use its reserves to hold down rates.

By Chad Terhune, Los Angeles Times
December 13, 2012

Health insurer Blue Shield of California wants to raise rates as much as 20% for some individual policyholders, prompting calls for the nonprofit to use some of its record-high reserve of $3.9 billion to hold down premiums.

In filings with state regulators, Blue Shield is seeking an average rate increase of 12% for more than 300,000 customers, effective in March, with a maximum increase of 20%.

Some consumer advocates and healthcare economists say Blue Shield shouldn’t be raising rates that high when it has stockpiled so much cash. The company’s surplus is nearly three times as much as the Blue Cross and Blue Shield Assn. requires its member insurers to hold to cover future claims.

“Blue Shield is sitting on a huge surplus that is beyond what is required or necessary,” said Laurie Sobel, a senior attorney for Consumers Union in San Francisco. “It should be used to hold down rate increases when it hits these extraordinary levels.”

California officials can take into account an insurer’s amount of surplus, among many other factors, when determining whether they think a rate increase is reasonable. Both the California insurance commissioner and the state Department of Managed Health Care are reviewing the company’s proposed premiums, but neither agency has the authority to reject changes in rates.

Some other states limit how much surplus can be held by nonprofit health plans. Other regulators press nonprofit insurers to return more money to consumers and the community overall since their stated mission is to serve the public good. Washington’s insurance commissioner has said the two big nonprofit Blue Cross and Blue Shield plans there hold enough surplus to allow a portion of it to be used to reduce rates.

At Blue Shield of California, based in San Francisco, reserves have jumped 77% since 2006 from $2.2 billion to $3.9 billion in September. That has outpaced the company’s 19% growth in annual revenue since 2006.

Blue Shield said its reserves have nothing to do with rate increases, and that money has been put aside for the future benefit of its policyholders.

“Reserves are needed to ensure our members’ claims can be paid no matter what,” said Blue Shield spokeswoman Lindy Wagner. “We need them to protect against uncertainties like a pandemic or another crisis.”

The company also expects higher costs from an influx of new customers under the federal healthcare law in 2014.

“It’s a once-in-a-lifetime change in the healthcare market that will bring a lot of volatility, and we need higher reserves for that,” Wagner said.

Even with these proposed rate increases, Blue Shield said, it expects to lose money in the individual insurance market in 2013.

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