For-profit non-conversion and regulatory firestorm at CareFirst BlueCross BlueShield

The attempted for-profit conversion of CareFirst BlueCross BlueShield culminated in two decades of drift from its nonprofit mission and opened a window of opportunity for Maryland to deny the proposal, replace the board majority, and impose oversight. Maryland rejected the approach used by some states, which have permitted conversion and used the erstwhile nonprofit's assets to endow a health-related foundation, because it sought an insurer with dominant market share to promote coverage expansions. Coupled with the ensuing conflict with insurance commissioners and nearby Blues plans, this incident signals the end of the "trust-me" era of nonprofit accountability in health insurance.