Big Blues May Benefit From Tentative Antitrust Settlement

The Blue Cross and Blue Shield Association (BCBSA) has reportedly reached a tentative settlement in a lengthy legal battle over whether its member plans engage in anticompetitive business practices. And although it may seem like a counterintuitive result for an antitrust lawsuit, the settlement’s terms will likely give Blues plans more freedom to collaborate and consolidate, industry analysts say.

The lawsuit in question was filed in 2012 on behalf of employers and policyholders who took issue with Blues plans’ agreement to divide the country among the association’s 36 members and to restrict members’ ability to offer non-Blues products. A related lawsuit filed by health care providers, which was then consolidated with the employer/policyholder lawsuit, alleged that the Blues’ anticompetitive practices improperly depressed their reimbursement. In 2018, a federal judge delivered a boost to the plaintiffs’ case by deciding that the burden of proof falls on BCBSA to prove its practices are not anticompetitive (HPW 5/7/18, p. 9) — a decision that held up on appeal later that year.

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Leslie Small

Leslie has been reporting and editing in various journalism roles for nearly a decade. Most recently, she was the senior editor of FierceHealthPayer, an e-newsletter covering the health insurance industry. A graduate of Penn State University, she previously served in editing roles at newspapers in Pennsylvania, Virginia and Colorado.

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