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Blue Shield Spotlight

What's ahead for health care in 2008?

This is a question everyone is pondering.  Since January, a day has not passed without receiving an invitation to an audio conference or an offer to purchase a book from experts predicting what forces are at work shaping the health care industry this year.

With more than 6 billion uninsured, are the forces at hand really any different than those tackled for more than a decade by managed care organizations, providers, payers and the legal system? Health care costs continue to rise dramatically, employers are still wrestling with rising premiums, employees resent sharing more of the costs, providers grapple with lower reimbursement rates and several layers of the government are still trying to figure out how to best manage the uninsured.

In December 2007, the Henry J. Kaiser Family Foundation1 reported that more Americans are personally worried about health care costs than about paying their rent or mortgage, being a victim of a terrorist attack or a violent crime, losing their job or losing money in the stock market.

Nearly half of adults surveyed (46%) said that they are very worried about their income not keeping up with rising prices, and about as many said the same about having to pay more for their health care or health insurance (41%).  Roughly about a third worried about not being able to afford the health care services they think they need (35%), or the quality of the care getting worse (33%) or the plan being more concerned about saving money than about what treatment is best for them (33%). 

Although the worries historically differ for different demographic groups and income levels, people consistently express the highest level of worry about their income falling behind rising prices and having to pay more for health care and insurance. 

True to our mission
While the cost drivers may change each year due to advances in medical technology and trends impacting hospitals and physicians, Blue Shield has remained true to its mission -- to provide Californians with access to high-quality health care at a reasonable cost.  Each year we work hard to effectively reduce health care costs and deliver innovations aimed at driving real, sustainable results.

2008 will be no different. We’ll continue to tackle many of the cost pain points and challenges at hand with the goals of keeping rates affordable and controlling employers’ and members’ out-of-pocket expenses.  What can you expect from us?

  • Continued efforts to reduce inappropriate utilization and increase support to help consumers take personal responsibility for their health through targeted programs. 
  • Improved transparency tools to allow consumers to make more informed choices about doctors and hospitals.
  • Effective medical management that focuses on risk reduction, condition improvement and decreasing the burden of illness in financial cost and quality of life.2
  • Continued advocacy for universal coverage.

Look for information on these advances in future editions of Shield Spotlight.

For a complete copy of the Kaiser Health Security Watch December 2007 report visit

1Kaiser Health Security Watch, December 2007

2Source: Staywell Health Management Reporting, Change in Number of Health Risks Pre/Post for 2004 HLR participants

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Massachusetts Makes Health Insurance Mandatory

As a possible sign of things to come for all states, Massachusetts has made health insurance mandatory for every adult resident. Although Governor Romney signed into law the Massachusetts’ Act Providing Access to Affordable, Quality, and Accountable Health Care on April 12, 2006, the first effective date was July 1, 2007 when Massachusetts residents age 18 or older were required to obtain and maintain health insurance by December 31, 2007.

The foremost intent of the law is universal health coverage by requiring Massachusetts residents to maintain minimal creditable coverage.  Certain businesses that do not offer health insurance will pay penalties to support programs designed to increase health coverage, including a program of subsidized health insurance provided to low-income residents.

The law affects Blue Shield because we offer PPO plans to employers who have employees who reside in Massachusetts.

Because Massachusetts requires that all residents have health insurance, Blue Shield will help the residents who are members of our health plans verify that they have coverage.

No Impact on Blue Shield of California Producers
This new law will have absolutely no impact on how you sell plans or run your business.  Blue Shield has a process already in place to supply the required proof of insurance at the end of each new year to Massachusetts residents with Blue Shield health plans. 

Blue Shield of California will supply all Massachusetts residents with the required proof to send with their state tax returns.

No Changes to Blue Shield Plans
A key provision of the Massachusetts Health Care Reform Law is known as minimum creditable coverage. This provision requires that as of January 1, 2009, individuals must be enrolled in health insurance policies that meet certain standards.

This provision does not apply to Blue Shield health plans – the minimum creditable coverage requirements only apply to contracts written and issued in the state of Massachusetts.  We will not need to amend our health plans to meet these requirements.

We’re excited that Massachusetts is taking the lead on universal health care coverage and hope that California won’t be far behind in making universal coverage mandatory. 

As other states follow suit with similar laws, Blue Shield will remain proactive and continue to support every member, regardless of where they live, by providing proof of insurance documentation whenever necessary.

If you have any questions about Massachusetts’ new law or how it may impact members living in Massachusetts, please feel free to contact your Blue Shield sales representative.

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