Blue Cross of Iowa v. Foudree

606 F. Supp. 1574, 53 U.S.L.W. 2577, 1985 U.S. Dist. LEXIS 20164
CourtDistrict Court, S.D. Iowa
DecidedMay 2, 1985
DocketCiv. No. 84-597-A
StatusPublished

This text of 606 F. Supp. 1574 (Blue Cross of Iowa v. Foudree) is published on Counsel Stack Legal Research, covering District Court, S.D. Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blue Cross of Iowa v. Foudree, 606 F. Supp. 1574, 53 U.S.L.W. 2577, 1985 U.S. Dist. LEXIS 20164 (S.D. Iowa 1985).

Opinion

RULING AND ORDER

STUART, Chief Judge.

Plaintiffs, Blue Cross of Iowa [hereinafter “Blue Cross”] and Blue Shield of Iowa [hereinafter “Blue Shield”], brought this action against defendant, the Insurance Commissioner of the State of Iowa, on August 16, 1984. In their complaint, plaintiffs sought rulings (1) that Iowa Code Section 514.4 (1985) and Iowa Administrative Code § 510 — 34.7 violate the due process clauses, taking clauses, and contract clauses of the United States and Iowa Constitutions, and (2) that Iowa-Administrative Code § 510 — 34.7 is invalid as a matter of administrative rulemaking authority and statutory construction. Plaintiffs also moved for a preliminary injunction against enforcement of the challenged law and regulation on August 16.

On August 22, 1984, the Health Policy Corporation of Iowa, the Iowa Federation of Labor, and three Blue Cross-Blue Shield subscribers moved to intervene in order to defend the constitutionality of the challenged law and regulation. The motion to intervene was granted on August 31, 1984.

The Court heard arguments on plaintiffs’ motion for preliminary injunction on August 31, 1984. At the hearing, the parties agreed that the federal constitutional issues could be deemed fully submitted without further hearing pursuant to Federal Rule of Civil Procedure 65(a)(2). The parties were given time to brief the federal constitutional issues and the issue whether the pendent state law questions should be certified to the Iowa Supreme Court. The Court granted the motion for preliminary injunction at the close of the hearing.

Defendant filed a motion to dismiss all state law claims from the complaint on the morning of the preliminary injunction hearing. After the motion had been resisted, the Court granted the motion to dismiss all state law claims on October 30, 1984. The Court was concerned that the Reserved Powers Clause of the Iowa Constitution might have been interpreted by the Iowa Supreme Court as an independent limitation on the Iowa Legislature’s power to amend corporate charters. Thus, the Court indicated in its October 30 Order that it would stay its consideration of the federal constitutional issues, and that the preliminary injunction would extend sixty more days, allowing plaintiff time to seek a pre[1576]*1576liminary injunction in state court under the Reserved Powers Clause.

On November 13, 1984, plaintiff moved the Court to reconsider its determination that the Reserved Powers Clause was an independent limitation. A hearing on the plaintiffs motion was held on December 13, 1984. After hearing the statements of counsel, the Court reconsidered its prior determination, and determined that the Reserve Powers Clause was not an independent limitation. In addition,' the Court found that the federal constitutional issues were fully submitted, and extended the preliminary injunction until a decision on the merits was made.

Blue Cross was incorporated as a nonprofit corporation in 1939. Since 1939, Blue Cross has at all times been authorized to do business as a hospital service plan under the provisions of Iowa Code Chapter 514. Blue Shield was incorporated as a nonprofit corporation in 1945. At all times since 1945, Blue Shield has been authorized to do business as a medical and surgical service plan under the provisions of Iowa Code Chapter 514. Plaintiffs were established through private initiative, with a relatively small amount of seed money being provided by health care providers.

Plaintiffs were incorporated for the express purpose of establishing, maintaining, and operating a nonprofit hospital service plan (Blue Cross) and a nonprofit medical and surgical service plan (Blue Shield) whereby health care services would be provided at the corporation’s expenses to those entering into contracts with the corporation (subscribers). According to plaintiffs’ President, D. Eugene Sibery, plaintiffs’ purpose is to provide subscribers with high quality health care coverage at affordable costs, while working with providers to accomplish the purpose.

As special nonprofit health care corporations, plaintiffs have throughout their existence been subject to a much higher degree of state regulation than have commercial health insurers or other corporations. Plaintiffs’ articles of incorporation must be approved by defendant before they are effective. To assist the plaintiffs in meeting their purpose of providing health care services to Iowans, the State of Iowa has given plaintiffs several advantages over their commercial competitors. These advantages include an exemption from both the state insurance premium tax and all other provisions of the state insurance laws.

Plaintiffs had been required by former Iowa Code Section 514.4 to maintain at least a simple majority of health care providers on their respective boards of directors. Nomination of board members had been by the boards themselves, the boards’ nominating committees, or the members of the corporation. Subscribers have often comprised a substantial portion of plaintiffs’ boards. In fact, plaintiffs’ President testified that currently eleven-twenty-thirds of the Blue Shield board are subscribers, and subscribers comprise the majority of the Blue Cross board.

Both Blue Cross and Blue Shield membership is effectively controlled by providers who have contracts with the corporations. With few exceptions, plaintiffs’ members have at all times been health care providers under contract with plaintiffs. Plaintiffs’ members do not invest any funds in plaintiffs in order to obtain membership. The sole pecuniary interest of the members is a very limited exposure for corporate losses.

Plaintiffs have come to be the largest health insurance organizations in Iowa. They operate throughout the state, and have over 700,000 contracts providing coverage for over 1.4 million Iowans. Blue Cross controls over thirty-eight percent of the Iowa hospital services insurance market. Blue Shield controls approximately thirty-five percent of the Iowa medical and surgical services insurance market.

In order to provide insurance, plaintiffs enter into contracts with members of the public, known as subscribers, and health care providers, such as hospitals and physicians. A subscriber contract binds plaintiffs to pay for the subscriber’s health care services in return for the subscriber’s payment of established premiums. A provider contract requires a health care provider to [1577]*1577provide services to plaintiffs’ subscribers in return for the provider’s agreement to accept certain amounts as payment in full for services. Plaintiffs, therefore, control a large share of the health care insurance market and are in the position to negotiate with subscribers and providers to establish premiums and payments for health care services.

In 1978, the Subcommittee on Oversight and Investigations of the United States House of Representatives’ Committee on Interstate and Foreign Commerce found that there was a serious conflict of interest problem created by physician domination of most Blue Shield boards of directors. Physicians were found to comprise a majority of the boards of forty-four of the sixty-nine Blue Shield plans. In addition, the Subcommittee found that many nonphysician board members were persons selected by physicians or persons with close ties to the health care industry. This led the Subcommittee to conclude that the common practices of the Blue Shield plans permitted

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Bluebook (online)
606 F. Supp. 1574, 53 U.S.L.W. 2577, 1985 U.S. Dist. LEXIS 20164, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-of-iowa-v-foudree-iasd-1985.