Blue Cross and/or Blue Shield (BCBS) organizations along with their affiliates enrolled 98.7 million people as of September 30, 2013, more than 31% of the population in the United States and 40% of those commercially insured. Linked together through the Blue Cross and Blue Shield Association (BCBSA), the Blues are a national federation of 36 local Blue Cross and Blue Shield entities, down from 39 five years ago. Most Blues organizations operate individually and in a single local market. However, that is shifting and consolidation among Blues continues as plans position to compete more effectively against publicly-traded rivals, such as UnitedHealthcare, according to Mark Farrah Associates’ latest Business Strategy Report.
Seven Blues organizations conduct business in multiple states. In the third quarter of 2013, Blue Cross Blue Shield of Montana and Health Care Service Corporation (HCSC – which operates Blues plans in Illinois, Texas, Oklahoma and New Mexico) completed their affiliation. HCSC is the fifth largest health plan in the U.S.
MFA found approximately 90% of BCBS enrollment is from Commercial sources and that BCBS and affiliated organizations did worse than non-Blues affiliated companies in terms of commercial (Individual major medical, Group major medical, FEHBP and ASO business combined) enrollment. From third quarter 2012 to third quarter 2013, Non-Blues entities saw a 2.2% increase in total commercial enrollment and BCBS entities saw a -1.2% decline. This trajectory is expected to change as Blues organizations throughout the country are participating in the new individual marketplaces.