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As presented to the Michigan Senate Insurance Committee, Sept. 20, 2012




Governor Snyder’s Plan to
Modernize Michigan’s Health
Insurance Market
Briefing
While Governor’s plan is not what BCBSM would have proposed, it largely
meets BCBSM’s principles of regulatory reform




             BCBSM’s guiding principles for reform:
             ▪   Reform should allow BCBSM to remain a non-
                 profit, Michigan based company
             ▪   Reform should allow BCBSM to continue our
                 mission to expand access to affordable care and
                 improve the health of the people of Michigan
             ▪   Reform should create a level-playing field within
                 Michigan; where all insurers play by the same rules
             ▪   Reform should not negatively impact the strong
                 relationships we have with our stakeholders




                                                                          1
Key elements of the Governor’s plan would modernize Michigan’s health
insurance market



        These are the key points we would like to cover with you
        today regarding the Governor’s plan:
        1. Regulates all health insurers under the same set of rules –
           creating a level playing field to increase competition, reduce
           health care costs, improve quality, and give customers more
           choices while also ensuring that BCBSM pays state taxes
        2. Establishes an unprecedented $1.5 billion contribution from
           BCBSM for the health of Michigan’s people
        3. Ensures that BCBSM will continue to be a nonprofit, Michigan
           based health insurer providing access to high-quality, affordable
           health insurance for Michigan citizens




                                                                               2
LEVEL PLAYING FIELD
Governor Snyder’s plan regulates all health insurers under the same set of
rules, giving Michigan modern regulations that encourage a stronger
marketplace

                       ▪   The proposal entails that:
                           – Legislation would allow BCBSM to transition to a
  A level playing            nonprofit mutual under the insurance code
  field would              – BCBSM board would have to approve the transition
  increase com-        ▪   This levels the playing field because:
  petition, reduce
  health care costs,       – All health insurers would be regulated under the
  improve quality,           Insurance Code and will play by the same rules
  and give                 – BCBSM would have to pay state and local taxes like
  customers more             commercial insurance companies
  choice
                           – BCBSM will not have any special regulatory
                             advantages or burdens – it will be regulated under the
                             same rules as commercial insurers




                                                                                      3
LEVEL PLAYING FIELD
Governor’s proposal transitions BCBSM into a nonprofit mutual company


        What is a mutual?
        ▪   A mutual is a common governance structure for an organization
            – Some of the most well known organizations in Michigan are
              organized as a mutual, including Farm Bureau and AAA
            – There are 12 other Blues mutuals in 14 states
        ▪   BCBSM wants to remain nonprofit, thus an amendment is required
            to the insurance code to create a nonprofit mutual
        ▪   Ownership of a mutual resides with its members

                ▪   BCBSM would pay the same Michigan taxes as
                    commercial insurers
                ▪   The nonprofit distinction allows us to retain our
                    focus on providing access to affordable care by
                    keeping costs and margins low, not maximizing
                    profit


                                                                             4
UNPRECEDENTED CONTRIBUTION
The $1.5 billion contribution is an unprecedented opportunity for Michigan


                      ▪ BCBSM would contribute $1.5 billion over 18 years to
                        a nonprofit entity established to invest in key health care
                        priorities for the people of Michigan
                        – Health care access
                        – Health care affordability
 BCBSM will make
 a $1.5 billion
                        – Health care quality
 contribution in        – Improving the health of Michigan’s residents
 support of         ▪ The new nonprofit entity will be governed by a Board and
 creating a           Advisory Council structure comprised of key health care
 healthier Michigan   stakeholders and experts
                      ▪ Our expectation is that the $1.5 billion contribution will be
                        used for health care programs and there will be specific
                        standards and metrics in place to ensure strong outcomes
                      ▪ The non profit entity has the potential to generate an annuity
                        stream that can serve generations of Michigan residents with
                        long-lasting impact


                                                                                         5
UNPRECEDENTED CONTRIBUTION
$1.5 billion contribution can be used for health care programs to make a
significant impact on Michigan health

  Michigan is currently ranked 30th out of 50 states on its overall                …and improvements to health status can
  health status…                                                                   drive significant economic competitiveness
  State health status indicator composite score                                    ▪   Poor population health drives significant
  relative to national weighted average                                                labor force productivity and economic
  Average ranking, 2000-2009                                                           performance loss
     Top quartile                                                                      – Lost economic output due to health
                                                                                            reasons represents $260 billion per
                                                                             MS             year in the United States1
                                                                             #50
                                                                                   ▪   Given Michigan’s health status ranking, it
                                                                                       is likely to bear a disproportionate share of
                                                                                       this economic loss
                                                                                   ▪   BCBSM’s contributions can drive a
         M                                                                             significant reduction in the economic loss
         N                                     MI                                      by:
                                               #30                                     – Improve the citizens’ health
         #1
                                                                                       – Improve overall productivity
                                                                                       – Create a more competitive business
    ▪     Michigan is ranked number 30 based on its overall health                           climate with lower health care costs
          status indicator; ranking lower on key health care areas are
          as follows:                                                              ▪   Even a modest improvement (e.g., 5%)
            – Number 39 on diabetes                                                    could drive as much as a half-billion
            – Number 33 on smoking                                                     dollars in annual productivity gain,
            – Number 42 on obesity                                                     encouraging a more competitive business
    ▪     Focused, outcome driven spending could result in                             climate
          significant improvements even by attaining national
          average

  1 Health reasons include not working, sick days, and subpar productivity
  Source: The Commonwealth Fund (2005), www.americashealthrankings.com                                                                 6
UNPRECEDENTED CONTRIBUTION
BCBSM’s $1.5 Billion contribution would far exceed any other                                                                          EXAMPLES

contribution from nonprofit to nonprofit transitions
                                                                                     Current
                Nonprofit                        Total contributions                 Membership Year of
                mutuals1                         $ Millions                          Millions   mutualization

                 New Mexico1                                55                             0.4                 2001

                 Texas                                10                                   4.8                 1998

                 Iowa                             0                                        1.8                 1991

                 Kansas                           0                                        0.9                 1992

                 Mississippi                      0                                        0.6                 1996

                 North Dakota                     0                                        0.4                 1997
                                                                           $1.5
                 Proposed Michigan                                                         4.4                 2012
                                                                           billion

                        ▪ Contribution would be larger than any other nonprofit mutuali-
                             zations (even when adjusting for membership and inflation)2
                        ▪    BCBSM is committed to nonprofit status and to retain jobs
                             within Michigan
1 Total contributions of $55M; $20M endowment to its Foundation and $35M towards existing liabilities
2 Adjustment contribution assumed contribution based on 4.3M members and adjusted for inflation; average inflation from 1991-2011 assumed
  2.6% (CPI)
                                                                                                                                             7
UNPRECEDENTED CONTRIBUTION
A “valuation” is not the right tool to use when looking at BCBSM’s
unprecedented contribution

        A “valuation” is not appropriate because:

              BCBSM is neither being sold nor being converted to a for-profit
               company

              In cases where a nonprofit converts to a for-profit company, it is
               tradition to do a “valuation” of the assets of the nonprofit
               organization before those assets become property of a
               company, rather than the community

              While this legislation will not allow BCBSM to become a for-profit
               company, if in the future the law was changed, the people of
               Michigan would then be entitled to proceeds equal to the fair
               market value of Blue Cross and its subsidiaries at the time of the
               transaction

            BCBSM is not converting to a for-profit governance
            structure, but rather is transitioning to another model of
            non-profit governance

                                                                                    8
COMMITMENT TO MICHIGAN
Governor’s proposal guarantees that BCBSM will continue to be a
nonprofit, Michigan-based health insurer



                     ▪ The legislation would not allow BCBSM to become a
                         for-profit company
 BCBSM has been      ▪ BCBSM would not be sold to an out of state
 and will always         company, preserving jobs and growth opportunities
 be committed to         here in Michigan
 being a Michigan
 company serving     ▪ BCBSM will continue to be governed with members
 the people of           on its board of directors representing diverse health
 Michigan                care stakeholders
                     ▪ BCBSM will continue to serve as insurer of last
                         resort until 2014, when all insurers will share that
                         responsibility




                                                                                 9
COMMITMENT TO MICHIGAN
BCBSM will remain committed to Michigan


                       Michigan cities:         • BCBSM is a Michigan company, an
                       97% of Blue                independent licensee of the Blue
   Michigan jobs:      workforce is
   BCBSM supports
                                                  Cross and Blue Shield Association, that
                       located in the
   over 7,000 jobs     downtown areas
                                                  represents our members to ensure
                       of                         they have access to the health care
                       Detroit, Lansing           they need, when they need it and at a
                       and Grand Rapids           price they can afford.
                                                • For the past 70 years, BCBSM has
                       Michigan health:           worked as a committed partner with
   Michigan            Provides health            health care
   economy:            insurance to over          providers, businesses, labor, state
   BCBSM has spent     4 million                  government and consumers to
   over $331 million   people regardless
                                                  improve Michigan all around
   in 2010             of zip code




       BCBSM’s goals and purpose would remain the same:
       Remain committed to Michigan, expand access to health care, control
       health care costs, and improve health care quality
                                                                                            10
We should act now to modernize Michigan’s health insurance market


     ▪   A level playing field will benefit Michigan citizens because a
         modern, competitive marketplace improves quality, expands choices
         and controls costs
     ▪   A $1.5 billion unprecedented commitment will help the people of
         Michigan by investing in key health care priorities
     ▪   There is significant conflict between our current regulatory processes
         and the federal regulatory structure beginning early next year
         – BCBSM requires regulatory clarity to make significant business
           decisions
         – Making decisions without clarity will have a negative impact in the
           market place and on consumer choice

            Governor Snyder’s plan does not establish the exchange
            or the ACA in Michigan. It will, however, ensure that
            Michigan’s health insurance market place will work better
            regardless of whether the ACA stays in place

                                                                                  11
Conclusion




       Key features of Governor’s plan:
       1. Regulates all health insurers under the same set of rules –
          creating a level playing field to increase competition, reduce
          health care costs, improve quality, and give customers more
          choices while also ensuring that BCBSM pays state taxes
       2. Establishes an unprecedented $1.5 billion contribution from
          BCBSM for the health of Michigan’s people
       3. Ensures that BCBSM will continue to be a nonprofit, Michigan
          based health insurer dedicated to guaranteeing that all Michigan
          citizens have access to high-quality, affordable health insurance




                                                                              12

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Presented to the Michigan Senate Insurance Committee

  • 1. As presented to the Michigan Senate Insurance Committee, Sept. 20, 2012 Governor Snyder’s Plan to Modernize Michigan’s Health Insurance Market Briefing
  • 2. While Governor’s plan is not what BCBSM would have proposed, it largely meets BCBSM’s principles of regulatory reform BCBSM’s guiding principles for reform: ▪ Reform should allow BCBSM to remain a non- profit, Michigan based company ▪ Reform should allow BCBSM to continue our mission to expand access to affordable care and improve the health of the people of Michigan ▪ Reform should create a level-playing field within Michigan; where all insurers play by the same rules ▪ Reform should not negatively impact the strong relationships we have with our stakeholders 1
  • 3. Key elements of the Governor’s plan would modernize Michigan’s health insurance market These are the key points we would like to cover with you today regarding the Governor’s plan: 1. Regulates all health insurers under the same set of rules – creating a level playing field to increase competition, reduce health care costs, improve quality, and give customers more choices while also ensuring that BCBSM pays state taxes 2. Establishes an unprecedented $1.5 billion contribution from BCBSM for the health of Michigan’s people 3. Ensures that BCBSM will continue to be a nonprofit, Michigan based health insurer providing access to high-quality, affordable health insurance for Michigan citizens 2
  • 4. LEVEL PLAYING FIELD Governor Snyder’s plan regulates all health insurers under the same set of rules, giving Michigan modern regulations that encourage a stronger marketplace ▪ The proposal entails that: – Legislation would allow BCBSM to transition to a A level playing nonprofit mutual under the insurance code field would – BCBSM board would have to approve the transition increase com- ▪ This levels the playing field because: petition, reduce health care costs, – All health insurers would be regulated under the improve quality, Insurance Code and will play by the same rules and give – BCBSM would have to pay state and local taxes like customers more commercial insurance companies choice – BCBSM will not have any special regulatory advantages or burdens – it will be regulated under the same rules as commercial insurers 3
  • 5. LEVEL PLAYING FIELD Governor’s proposal transitions BCBSM into a nonprofit mutual company What is a mutual? ▪ A mutual is a common governance structure for an organization – Some of the most well known organizations in Michigan are organized as a mutual, including Farm Bureau and AAA – There are 12 other Blues mutuals in 14 states ▪ BCBSM wants to remain nonprofit, thus an amendment is required to the insurance code to create a nonprofit mutual ▪ Ownership of a mutual resides with its members ▪ BCBSM would pay the same Michigan taxes as commercial insurers ▪ The nonprofit distinction allows us to retain our focus on providing access to affordable care by keeping costs and margins low, not maximizing profit 4
  • 6. UNPRECEDENTED CONTRIBUTION The $1.5 billion contribution is an unprecedented opportunity for Michigan ▪ BCBSM would contribute $1.5 billion over 18 years to a nonprofit entity established to invest in key health care priorities for the people of Michigan – Health care access – Health care affordability BCBSM will make a $1.5 billion – Health care quality contribution in – Improving the health of Michigan’s residents support of ▪ The new nonprofit entity will be governed by a Board and creating a Advisory Council structure comprised of key health care healthier Michigan stakeholders and experts ▪ Our expectation is that the $1.5 billion contribution will be used for health care programs and there will be specific standards and metrics in place to ensure strong outcomes ▪ The non profit entity has the potential to generate an annuity stream that can serve generations of Michigan residents with long-lasting impact 5
  • 7. UNPRECEDENTED CONTRIBUTION $1.5 billion contribution can be used for health care programs to make a significant impact on Michigan health Michigan is currently ranked 30th out of 50 states on its overall …and improvements to health status can health status… drive significant economic competitiveness State health status indicator composite score ▪ Poor population health drives significant relative to national weighted average labor force productivity and economic Average ranking, 2000-2009 performance loss Top quartile – Lost economic output due to health reasons represents $260 billion per MS year in the United States1 #50 ▪ Given Michigan’s health status ranking, it is likely to bear a disproportionate share of this economic loss ▪ BCBSM’s contributions can drive a M significant reduction in the economic loss N MI by: #30 – Improve the citizens’ health #1 – Improve overall productivity – Create a more competitive business ▪ Michigan is ranked number 30 based on its overall health climate with lower health care costs status indicator; ranking lower on key health care areas are as follows: ▪ Even a modest improvement (e.g., 5%) – Number 39 on diabetes could drive as much as a half-billion – Number 33 on smoking dollars in annual productivity gain, – Number 42 on obesity encouraging a more competitive business ▪ Focused, outcome driven spending could result in climate significant improvements even by attaining national average 1 Health reasons include not working, sick days, and subpar productivity Source: The Commonwealth Fund (2005), www.americashealthrankings.com 6
  • 8. UNPRECEDENTED CONTRIBUTION BCBSM’s $1.5 Billion contribution would far exceed any other EXAMPLES contribution from nonprofit to nonprofit transitions Current Nonprofit Total contributions Membership Year of mutuals1 $ Millions Millions mutualization New Mexico1 55 0.4 2001 Texas 10 4.8 1998 Iowa 0 1.8 1991 Kansas 0 0.9 1992 Mississippi 0 0.6 1996 North Dakota 0 0.4 1997 $1.5 Proposed Michigan 4.4 2012 billion ▪ Contribution would be larger than any other nonprofit mutuali- zations (even when adjusting for membership and inflation)2 ▪ BCBSM is committed to nonprofit status and to retain jobs within Michigan 1 Total contributions of $55M; $20M endowment to its Foundation and $35M towards existing liabilities 2 Adjustment contribution assumed contribution based on 4.3M members and adjusted for inflation; average inflation from 1991-2011 assumed 2.6% (CPI) 7
  • 9. UNPRECEDENTED CONTRIBUTION A “valuation” is not the right tool to use when looking at BCBSM’s unprecedented contribution A “valuation” is not appropriate because:  BCBSM is neither being sold nor being converted to a for-profit company  In cases where a nonprofit converts to a for-profit company, it is tradition to do a “valuation” of the assets of the nonprofit organization before those assets become property of a company, rather than the community  While this legislation will not allow BCBSM to become a for-profit company, if in the future the law was changed, the people of Michigan would then be entitled to proceeds equal to the fair market value of Blue Cross and its subsidiaries at the time of the transaction BCBSM is not converting to a for-profit governance structure, but rather is transitioning to another model of non-profit governance 8
  • 10. COMMITMENT TO MICHIGAN Governor’s proposal guarantees that BCBSM will continue to be a nonprofit, Michigan-based health insurer ▪ The legislation would not allow BCBSM to become a for-profit company BCBSM has been ▪ BCBSM would not be sold to an out of state and will always company, preserving jobs and growth opportunities be committed to here in Michigan being a Michigan company serving ▪ BCBSM will continue to be governed with members the people of on its board of directors representing diverse health Michigan care stakeholders ▪ BCBSM will continue to serve as insurer of last resort until 2014, when all insurers will share that responsibility 9
  • 11. COMMITMENT TO MICHIGAN BCBSM will remain committed to Michigan Michigan cities: • BCBSM is a Michigan company, an 97% of Blue independent licensee of the Blue Michigan jobs: workforce is BCBSM supports Cross and Blue Shield Association, that located in the over 7,000 jobs downtown areas represents our members to ensure of they have access to the health care Detroit, Lansing they need, when they need it and at a and Grand Rapids price they can afford. • For the past 70 years, BCBSM has Michigan health: worked as a committed partner with Michigan Provides health health care economy: insurance to over providers, businesses, labor, state BCBSM has spent 4 million government and consumers to over $331 million people regardless improve Michigan all around in 2010 of zip code BCBSM’s goals and purpose would remain the same: Remain committed to Michigan, expand access to health care, control health care costs, and improve health care quality 10
  • 12. We should act now to modernize Michigan’s health insurance market ▪ A level playing field will benefit Michigan citizens because a modern, competitive marketplace improves quality, expands choices and controls costs ▪ A $1.5 billion unprecedented commitment will help the people of Michigan by investing in key health care priorities ▪ There is significant conflict between our current regulatory processes and the federal regulatory structure beginning early next year – BCBSM requires regulatory clarity to make significant business decisions – Making decisions without clarity will have a negative impact in the market place and on consumer choice Governor Snyder’s plan does not establish the exchange or the ACA in Michigan. It will, however, ensure that Michigan’s health insurance market place will work better regardless of whether the ACA stays in place 11
  • 13. Conclusion Key features of Governor’s plan: 1. Regulates all health insurers under the same set of rules – creating a level playing field to increase competition, reduce health care costs, improve quality, and give customers more choices while also ensuring that BCBSM pays state taxes 2. Establishes an unprecedented $1.5 billion contribution from BCBSM for the health of Michigan’s people 3. Ensures that BCBSM will continue to be a nonprofit, Michigan based health insurer dedicated to guaranteeing that all Michigan citizens have access to high-quality, affordable health insurance 12