Jessica Kourkounis for The New York Times
Last week, Independence Blue Cross had a converted semi at Rising Sun Health Center in Philadelphia, where residents could sign up for health insurance.
Color the new online insurance marketplaces Blue.
On the first day that people could buy coverage under the federal health care law last week, the chief executive of Independence Blue Cross in Philadelphia had just learned that his company's plans were the area's least expensive available through the new state exchanges. "We were thrilled," said Daniel J. Hilferty, the nonprofit insurer's chief executive.
A 36-year-old can buy a so-called silver policy — a midrange plan — for $246 a month, not including the federal subsidies that could lower the cost even further. Out-of-pocket costs would vary, depending on the choice of hospital and doctor.
While other brand-name insurers like UnitedHealth Group, Aetna and Cigna are selling coverage only sporadically on the exchanges, consumers will find local nonprofit Blue Cross and Blue Shield plans in nearly every state and market in much the same way they did before the federal health law was enacted.
WellPoint, which became one of the nation's largest insurers by combining more than a dozen Blue Cross plans into a profit-making company, is also actively participating in the exchanges in all 14 states where it operates. "We expect to be a strong competitor in most regions because our brand and local market experience are meaningful differentiating factors," the company's chief executive, Joseph R. Swedish, recently told investors.
The dominance of Blues plans and their aggressive stance illustrates just how little — and how much — the health insurance market is changing under the Affordable Care Act. The nation's Blue Cross and Blue Shield plans have typically been the largest insurers providing coverage primarily to individuals and small businesses, and they remain a staple on the new exchanges.
Originally created by hospitals and doctors to help patients pay for medical care, the nonprofit Blue Cross and Blue Shield plans do not have to generate a return to investors, so they say they can afford to offer policies that may not yield much profit.
What is not yet clear is whether the Blues plans are offering low prices to gain customers, only to raise prices in later years. And while people may be drawn to their strong brand name, the Blues are offering some plans that are very different from the ones people have through employers, with many fewer choices of doctors and hospitals.
The Blue Cross plans, including the profit-making ones run by WellPoint, also have the most to lose if they do not participate in the exchanges. Because so much of their existing business comes from selling policies to individuals and small groups, unlike the national insurers that cater to large employers, they cannot risk having their existing customers switch to a competitor.
The Blues plans "have to play," said Dr. Sanjay B. Saxena, an executive with Booz & Company, the consulting firm.
The health care law has fundamentally altered the competitive landscape by encouraging a new wave of competitors and creating a marketplace that puts a much sharper focus on price, because individuals can so easily compare premiums on a single Web site. About a quarter of the insurers competing are new to the market. These newcomers — including insurers that had served the low-income Medicaid market, and plans offered directly by large hospital systems — often seek to offer the least expensive policies.
But the Blues plans, by exploiting their size and longstanding presence in a market, are also emerging as low-cost alternatives. They are frequently among the least expensive policies being offered, according to early analysis by Avalere Health, a Washington research firm, of the premiums being made public by the states and federal government.
In 8 of the 13 largest state markets in which the federal government is operating the exchanges, the Blue Cross plan is among the second-lowest-priced silver options, one of the four tiers established under the law. The silver plans are moderately priced policies that can require sizable out-of-pocket payments.
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