some text
File Photo The BlueCross and BlueShield logos hang on the company's old building in downtown Chattanooga.

By the numbers

* $6 million - Net income in 2015, down from $199.7 million the previous year

* $11.8 billion - Total revenues from all BlueCross plans, up 9.8 percent from the previous year

* $449 million - Total taxes paid by BlueCross last year

* 4,937 - Number of BlueCross employees in Chattanooga (includes 52 interns) among the 6,000 employees companywide

ObamaCare in Tennessee

* 166,425 participants enrolled by BlueCross among 268,867 people signed up for coverage

* $170 million - Net loss by BlueCross from such plans in 2015, up from the $141 million loss the previous year

* 36.3 percent - Average premium rate increase for marketplace plans by BlueCross in 2016

* $104 - Average premium paid for marketplace plans by people qualifying for tax credits in 2015, up 2 percent from the previous year

* 85 - Percent of those on Obamacare plans receiving tax credits

* 22 percent higher medical expenses for new enrollees under Obamacare than for already insured group members nationwide due to worse health conditions for new enrollees

Sources: BlueCross BlueShield of Tennessee, U.S. Department of Health and Human Services


BlueCross BlueShield 2015 financial performance


Obamacare has helped extend health insurance coverage to more than 250,000 Tennesseans, but covering those enrolled in the new marketplace plans is proving costly for Tennessee's biggest health insurer.

In the first two years of offering the new plans under the Affordable Care Act, BlueCross BlueShield of Tennessee lost $311 million on such plans. The insurer says it is continuing to lose money again this year from Obamacare even after raising average premiums in the program by more than 60 percent over the past two years.

Despite the ongoing losses, BlueCross officials say they remain committed to participating in the marketplace exchange plans offered for individuals without access to other health insurance under Obamacare. But to cut future losses, the Chattanooga-based insurer may ask state regulators for additional rate increases next year even higher than the 36.3 percent implemented in January on its marketplace plans.

"We do feel there is potential and we're committed to serving this market," BlueCross Vice President Roy Vaughn said. "We're working hard to make it work in Tennessee, but we recognize we need to make some changes because ultimately each of our business lines have to cover their own costs."

BlueCross offers marketplace plans to 166,425 Tennesseans, or nearly two thirds of all those persons in the Volunteer State enrolled in the Obamacare insurance plans that began in 2014. In the company's annual financial filings for 2015, BlueCross reported a $170 million net loss from such plans. That followed a $141 million loss from the same program in 2014. Vaughn said BlueCross is continuing to see "substantial losses" from Obamacare in 2016.

Overall as a company, BlueCross still eked out a modest $6 million net income in 2015 from all of its businesses, primarily due to investment income and gains from group commercial insurance plans and BlueCare plans offered under Tennessee's Medicaid program.

But for the first time since BlueCross consolidated as a single statewide plan two decades ago, the Tennessee insurer reported an after-tax loss from its insurance operations. The company's net loss from operations of $21 million was offset by $27 million in investment income from its $1.8 billion in statutory reserves to generate the bottom line profit of $6 million.

Last year's net income was only a fraction of the $199.7 million BlueCross earned in 2014 or the record high profits of $256 million achieved in 2013. Vaughn said the net income earned by BlueCross over its 71-year history boosted reserves for the company to cushion against losses from the Obamacare plans in the past couple of years.

"Last year demonstrates the value of our diverse business and what we have built up over the past 70 years," Vaughn said. "We did have good years leading up to this year, knowing that we were going to be facing some risks. We're still in a very strong position, but what is available for investments in the business and as a reserve for potential losses and claims is not as great of a share of our revenues as it once was."

Other health insurers are also bleeding red ink from their Obamacare plans, including a $485 million loss last year by UnitedHealthcare and a $400 million loss from the program reported by the Blue Cross plan in North Carolina.

In response, UnitedHealthcare plans to limit its participation in ObamaCare and withdraw any plans next year from Tennessee, Georgia and most other states. North Carolina Blue Cross CEO Brad Wilson said substantial rate increases will be needed for the North Carolina plan to keep offering Obamacare coverage in the Tar Heel state.

"There are systemic and fundamental challenges that we all need to have a civilized discussion about," Wilson told The Hill newspaper.

Tennessee's health care cooperative, the Knoxville-based Community Health Alliance, was forced to begin to phase out its Obamacare plans last year after suffering heavy losses.

Last week, Cigna and Humana indicated they will continue to offer Obamacare plans next year in Tennessee, although BlueCross will be the only insurer to offer plans in all 95 of Tennessee's counties. Humana said in a regulatory filing earlier this month that it will likely draw back from some U.S. markets with its Obamacare products due to losses in most markets. Aetna has offered to buy Humana, but Aetna remains wary about participation in Obamacare programs.

"We continue to have serious concerns about the sustainability of the public exchanges," Mark Bertolini, the CEO of Aetna, said earlier this year.

BlueCross CEO J.D. Hickey said all health insurers in Tennessee lost money on Obamacare last year, especially since the government cut off originally planned payments for covering higher risk individuals who are signing up for health insurance for the first time and are in need of immediate health care services. Tennessee also suffers from higher rates of obesity, diabetes and heart conditions than the U.S. as a whole, which tends to also drive up health care costs for health insurers in the state.

Hickey acknowledged that BlueCross didn't foresee all of the changes from the original Obamacare plan or the higher rates of sickness and health care utilization for those signing up for the marketplace plans.

Over time, supporters of Obamacare argue that providing primary care treatment in physician offices should help detect health care problems earlier when they can be treated easier and less expensively than having so many uninsured persons show up for treatment in hospital emergency rooms. But such cost advantages have yet to show up in the marketplace.

Even with above-average rate increases on its Obamacare plans over the past couple of years, Tennessee BlueCross rates for a typical 27-year-old with the most popular plan are still below the U.S. and Southeastern average, ranking 15th lowest among the states. In the first year of the program in 2014, Tennessee BlueCross rates were second lowest and last year they were still the 5th lowest among all states.

The losses from the ObamaCare plans last year for BlueCross offset nearly all of the gains the Chattanooga-based insurer made from its more profitably commercial insurance business and the investment gains on its reserves.


BlueCross maintained reserves that totaled $198 million above what the state required at the end of 2015. But the company's excess reserves have shrunk by 58 percent in the past couple of years as the company's membership has grown and Obamacare program losses have widened.

BlueCross also suffered losses from its early participation in Tennessee's Medicaid program, known as TennCare, in the 1990s before the state and BlueCross both revised their approaches. BlueCross said its TennCare plans, sold as BlueCare and TennCare Select, made money in 2015.

"As we did with TennCare, we will work to address the financial challenges of our marketplace exchange plans," Vaughn said.

For many low- and middle-income consumers, the rising costs for the Obamacare plans are being cushioned by tax credits provided for such plans by the federal government.

In Tennessee, 85 percent of those enrolled in one of the marketplace exchanges are getting a government subsidy for the coverage. The average monthly premium last year in Tennessee was up only 2 percent to $104, according to the U.S. Department of Health and Human Services.

"Our analysis highlights how different the premiums that people actually pay are from the rates that are initially proposed by issuers," said Richard Frank, assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services. "Consumers' actual health insurance premiums depend on whether they shop around for the best deal and the availability of tax credits that lower premium costs, both of which changed the picture dramatically in 2016."

Contact Dave Flessner at or at 757-6340