The state's largest health insurer has accumulated an "enormous" reserve of cash and lawmakers should consider using some of that money to help control surging rates, a national consumer advocacy group claims.
Blue Cross and Blue Shield of North Carolina has stockpiled a surplus of $1.4 billion with steady and steep rate hikes, Consumers Union reports in a study released today. The report examines the reserves of 10 nonprofit Blue Cross health plans across the country.
Blue Cross spokesman Lew Borman responded that the company is following North Carolina law that requires health insurers to keep three to six months' worth of claims and administrative costs in reserve. The company is actually at the lower end of that range, with about 3.6 months.
"Reserves are the safety net for our customers," Borman said. "It's about financial stability and providing ongoing coverage for our customers."
Blue Cross pays about $11 billion in claims each year for its 3.7 million members. If there is a health emergency or epidemic, the company will need to use its reserves to make sure customers continue receiving care, Borman said.
But as Consumers Union found at other Blue plans, the reserves at this state's Blue Cross are well above industry standards, and more than what's necessary to protect the insurer's financial health and ensure that claims are paid, the report's authors say.
Blue Cross should be forced to tap some of that cash before state regulators approve annual requests to raise rates, the group said.
"We need to balance the surplus levels with the large rate increases many people are seeing," said Laurie Sobel, a senior attorney with Consumers Union, the publisher of Consumer Reports magazine. "Consumers are struggling. We're asking regulators to take a hard look at this."
Consumers Union contends that insurance commissioners across the country should consider rejecting rate increases "when previously accumulated surpluses are sufficient to absorb potential underwriting losses."
The group focused on Blue Cross plans because they've become the dominant players in most states, Sobel said.
Blue Cross raised rates for individual coverage an average of 12 percent this year. Some members were hit with much higher increases.
The higher rates simply reflect the increasing use and skyrocketing cost of medical care, and Blue Cross' total margin is down, Borman said.
The Consumers Union report comes as new federal reform law calls on states to establish a process for reviewing "unreasonable" rate increases, the group said. And states can seek federal grants to improve their rate reviews.
The report also follows news that Blue Cross plans to slash administrative costs by 20 percent, or about $200 million, by 2014.
The strategy is aimed at improving financial results amid changes spurred by health reform, but also at keeping premiums down. Read the story on Blue Cross' plans to cut costs and revamp its business here.


Assistant Business Editor Alan M. Wolf joined the N&O in 1999 covering the business of health care. He became an editor in 2001, and helps oversee the paper's daily business coverage and Sunday Work&Money section. He lives in Clayton with his wife and two children. Reach him at 919-829-4572 or

Comments
No kidding. The amount
Thu, 07/22/2010 - 19:30 — jenuineNo kidding. The amount that BCBS actually reimburses medical charges keeps getting lower, look at one of your bills, it is a pittance on the dollar. The hospitals and doctors are forced to keep jacking it up to get some small percentage of what BCBS collects.
Of Course
Thu, 07/22/2010 - 16:57 — sicsempertyrannisWhy wouldn't anyone or any company stock pile money since barry is trying to put them out of business.
LC Industries is a
Thu, 07/22/2010 - 15:42 — JustShutUpLC Industries is a non-profit that the top two guys make close to what BCBS top execs do and I'm glad and proud of them for doing it. The Operations Manager came from the profit side of business and grew their revenue from $20M annually to well over $200M probably now approaching the $300M level. They increased the employment for the blind and seeing impaired by over 700 who now have jobs.
Being a non-profit doesn't mean you can't make a profit or save cash for a rainy day. The real secret is that working for a non-profit usually means you may make less but you almost always have better benefits and expense accounts. Go look at the AKC. Get place to work but not for the paycheck - the expense account. Now in bad years for revenue the expense account goes down but if it's a good year it can be great.
What do you guys think: "if a non-profit has done well make them give the money back." Any of you told your boss lately, "boss - you're over paying me please cut my paycheck." Yea, right.
Successful, reliable health insurance is obscene?
Thu, 07/22/2010 - 13:31 — WakeGuy2010I would much rather have a reliable, dependable health insurance company covering me and my family with a lot of money in reserves than an insurer on shaky ground or totally dependent upon the government for survival.
Yes,
Thu, 07/22/2010 - 15:05 — dsspr1a reserve 3 times the industry standard is obscene. Many people are struggling with healthcare costs or cannot even afford to have medical insurance as premiums constantly increase.
It is obscene.
Is the BC/BS reserve fund
Thu, 07/22/2010 - 16:00 — WakeGuy2010Is the BC/BS reserve fund keeping people from receiving coverage under BC/BS, or is the organization's financial stability making more coverage available? I'm sorry you don't like that fact that they are successful, I guess anyone who is successful is "obscene" such as students who get 4.0's, college scholarships, athletic championships, etc. I guess all those folks are "obscene" for doing the best they can. Please.
Please, indeed.....
Thu, 07/22/2010 - 17:23 — dsspr1comparing this "non-profit" scenario to "students who get 4.0's, college scholarships, athletic championships, etc." is ludicrous.
If the reserves are being held constant by annual customer policy increases that's fair, but if the annual increases are increasing the reserves to ever increasing levels above recognized industry standards, that's obscene, not "successful".
http://www.msnbc.msn.com/id/38354964
Wow, an MSNBC link, must be
Thu, 07/22/2010 - 18:01 — WakeGuy2010Wow, an MSNBC link, must be legit.
Some say "it's a mess"
Thu, 07/22/2010 - 11:18 — dsspr1I say it's obscene.
Non-Profit is to serve the public good -
Thu, 07/22/2010 - 11:05 — mikemayer@craco...Let's be honest. BCBS has done as well as they have because they are a virtual monopoly in NC with 95+% of the health insurance business one way or another and can pretty much do what they want - including denying legitimate claims. Even when Mr. Long held the leash they still were able to manipulate the system beyond what any other non-profit in NC has ever been able to pull off.
They are technically a non-profit but they act like a for-profit. Tell me two other non-profit Executive Directors in NC that make the salary that the head of BCBS makes. Not gonna happen. They have been trying to become a for-profit for several years - sometimes more obviously than others. This is more about the potential for huge payouts for the eventual stockholders than what is good for the public that a non-profit is supposed to serve.
I am the owner of a couple of businesses myself. I have no desire to become a socialist. I have nothing against making a profit - just dishonesty.
If they really cared about their policy holders as much as they would like you to believe they do, then their PR/advertising/lobbying budget line items would look a lot different because there would be no need to spend a small fortune sponsoring things like golf tournaments in Pinehurst and telling us how good they are on TV. Then they could make policies for small businesses that would like to insure their employees something that the business and employee could both afford.
It is a mess as someone commented earlier - but then greed usually is messy.
compete instead of complaining
Thu, 07/22/2010 - 10:53 — kedrowskIf there's so much money in the insurance business, maybe some of the fine folks at Consumers Union should leave and start up their own insurance business to compete against BCBS. That way, there'd be additional pressure on BCBS to serve its customers and it would give consumers/companies an additional choice. In my opinion, two (or more) entities striving to succeed is better than one entity striving to succeed and another entity striving to keep them shackled.
Re: compete instead of complaining
Sat, 07/24/2010 - 10:38 — piperTomKedrowsk suggests competition is the answer. It's a good point... if only competition were not FORBIDDEN BY LAW! All the blame here belongs with the legislature, which body makes "fixes" for "problems" and then has to make more "fixes" for the problems caused by their fixes. Let's call the whole thing off.
Income Distribution Is Theft of Private Property
Thu, 07/22/2010 - 10:14 — JustShutUpThe whole premise of this story is somehow that one group of people is encouraging government to steal from a private party what is theirs.
The government's job is to enforce the laws and regulations on the books. The government must approve all rate increases. This means they awarded the right for BCBS to raise it's rates or premiums. Here's the point - the government is the one who isn't executing their job performance duties at the higher end of the spectrum. Government is always on the lower end of the job performance spectrum. Anyone ever hear of a President or Senator or House Rep dedicate their office to raising the bar on job performance in the government. Yea, they'll give lip service to it but what do they usually do - nothing. I don't care whether it's nationally or at the state level the fix is in today - we are a corrupt people with a corrupt government all around. We are getting exactly what we asked for and vote for!
Hmmm
Thu, 07/22/2010 - 09:46 — WNCMikeIt is a tangled mess.
More class warfare...
Thu, 07/22/2010 - 09:21 — WakeGuy2010Waaaaaah! A business is successful and has stockpiled assets to survive a recession! Waaaah! Here is more info on the "grassroots" organization screaming at BC/BS for making money, it's straight from their website:
The organization generates more than $200 million in revenue, and a staff totaling more than 600 work at CU's 50 state-of-the-art labs and offices in Yonkers, N.Y.; its 327-acre Auto Test Center in East Haddam, Conn.; and our three advocacy offices, in Washington, D.C., Austin, Texas, and San Francisco.
I know how they accumulated
Thu, 07/22/2010 - 08:39 — TheLibertineI know how they accumulated this surplus: from not paying the bills. I sometimes wish my employer would just give me the money and let me manage my own healthcare. Insurance companies are parasites...just like big pharma; they exploit the American taxpayer daily.
@rod1972: I'm with you...when do I get my check?
BCBSNC Reserves
Thu, 07/22/2010 - 08:10 — PlatowasrightThis report and article fails to draw the distinction between INSURED covered lives and persons who are members of a self funded plan. The INSURED covered lives do need to maintain that monthly level of reserves. However, the large majority of BCBSNC's members are covered by health plans that are not insured by BCBSNC, but are covered by a plan owned by their employer who is responsible for the payment of the claims. The State Employees and Teachers plan is a good example. One half million of BCBSNC's "members" have a card that says they can use BCBSNC's health provider network, claims payment system, but the name on the card is the State of North Carolina,.... with BCBSNC as the plan administrator, not BCBSNC as the insurer. BCBSNC does not have to maintain reserves on these self funded lives that are the responsibility of the employer. They know this, but hide their " excess profits" behind the fallacy. The statutory responsibility to regulate the rates and level of reserves is held by the NC Commissioner of Insurance. Jim Long kept BCBSNC on a short leash. His successor, Wayne Williams appears to have taken his eye off the ball. Get in the game Commissioner Williams, you have the law behind you, make them lower their rates instead of socking away more money that leaves NC and just goes to Wall Street.
Blue Cross is non-profit.
Thu, 07/22/2010 - 10:12 — waweaverBlue Cross is non-profit. They pay NC taxes even though they don't have to and none of their "profits" go to Wall Street. They are not a publicly traded firm.
NCDOI commissioner Goodwin
Thu, 07/22/2010 - 08:37 — Umbro89Thanks for your insight on BCBSNC. Just a note to say that the NC Dept of Insurance commissioner is Wayne Goodwin (not Wayne Williams). Agree that he needs to take a second look at BCBS rates.
Just restore my previous deductible
Thu, 07/22/2010 - 08:04 — ZooterpustThe cost of my premiums (I'm private pay so am getting screwed more than most) went up so much this past year I had to cut way back on the deductible and copay. It cut my premium in half, but now I basically have an insurance policy that doesn't work at all unless I have a catastrophic event. They claim they have 13% overhead costs. I'll closer to 65% of my premium goes to overhead.
Blue Cross Big Ripoff
Thu, 07/22/2010 - 05:21 — rod1972I'll take my refund check now please.