Matthew Holt

Tom Epstein, Blue Shield of California, on the hot seat

A couple of weeks ago the PR company for Blue Shield of California contacted me asking if I wanted their take on health reform. I somehow suspect that the PR flack concerned wasn’t as familiar with the California rescission issue as I am, or hadn’t checked on THCB’s extensive coverage of it

But Blue Shield of California is an odd case. CEO Bruce Bodaken has been a leader among health plans in looking towards a regulated utility model, and supporting both Arnie-Care and now Obama/Baucus-care. On the other hand, as we’ve discussed numerous times on THCB, Blue Shield has not only been as bad as the rest in terms of bad behavior in the individual market–but has also been the most aggressive of all insurers in defending its right to that behavior in the courts.

Tom Epstein, is an old Clinton White House hand who’s now running Public Affairs at Blue Shield of California. Tom was brave enough to come on THCB, discuss the good, the bad and the ugly, be frank about what they want to happen and to forecast what he thinks might happen in terms of reform, and the potential role of health plans in it. Here’s the interview and I think you’ll find it very interesting.

8 replies »

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  2. why do we not have an open competitive market and let insurance companies from other states bid for my business, sounds like restraint of trade or some other bull shit. Every other kind of insurance company can sell here in California Tom Epsteins ” the increases are necessary to cover those costs” what does that mean, the cost of his high salary and i multi billion dollar return to whom, certainly not the policy holder, what the shell are they in the business for certainly not to take care of their customer most of whom would drop them like a bad habit if they had a alternative.

  3. o Unfortunately I am an employee of Blue Shield of California. I have to get some information to the public. Blue Shield implemented a process about two years ago. It’s called HVC (high valued customers). They rate IFP (individual and family plan) members on how they use their membership. Members that do not use, or use the least, are rated either an A or B rating and those members are given special treatment when it comes to plan options when wanting to change their coverage. Basically Blue Shield is discriminating against their members regarding plan changes. HVC members with a rating of A or B are able to change plans without an underwriting process and they are also able to speak with a “plan advisor” to help assist them in changing plans. Those members that are rated at a lower score (those that use the plan) do not have that option. These members that actually use the plan have fewer options when it comes to changing plans and are not able to reinstate a plan when cancelled for non-payment like an HVC A or B would be able to. As far as I am concerned this is discrimination. I brought this up during a Friday morning meeting and I was basically told to keep my mouth shut and that they knew what they were doing. I advised management that this is ultimately going to result in a class action law suits. I was dismissed of my comments and told to be quiet. I certainly feel guilty working for a company like this however I am a single parent and have children to support. I do what I can.

  4. Tom, that’s what I sound like! More seriously I’ve been meaning to upgrade my system, it’s just one more thing o a very very long list.

  5. Well, Matthew, maybe Nate can help you out with your insurance problem — he says he can. Might make a good case study for THCB.
    WRT risk adjustment preventing plans from avoiding risk: seems to me that some plans might specialize in managing very sick people, whilst others pursue a netural risk profile in their covered lives, and some might be willing to take a negative risk adjustment to deal with the “young healthies” as only they know how.
    The foregoing of course is predicated on the “re-legalization” of actual care-management, fraught with trust issues and all the rest. One ought to be able to write a contract that says something like “We’ll pay for whatever the UK’s system would pay for” and have it stick. But we have seen that the US House will pass ex post facto bills of attainder to effectively nullify a contract when they don’t like it. Sigh.
    Tech Note: there was lots of very annoying low frequency noise in the podcast when you were talking.

  6. I do not see why we can we not go for better solution…We should compromise on ideas and not the end goal. I am even not sure the current single payer is good enough.
    If you look at the layman’s way on this issue….you can not solve the problem unless someone gives in…
    And those who has been exploiting the system should give up…and there should not be any compromise.

  7. I thought it was a great interview. The two most important points that I took from it:
    People need to “leave their ideology at the door”. He was spot on when he said that a lot of single-payer advocates have closed their minds to anything but single payer and it is stalling reform. The same goes for those defending the status quo. It’s going to require pulling the best from both sides.
    The second point of everyone having “skin in the game” is the other key point. No one stakeholder should be disproportionately affected in a negative way because, contrary to what many have said, the contributions to this mess have been fairly equal across all stakeholder groups.