• Accelerate Louisiana: Through the sale, Blue Cross and Elevance would establish Accelerate Louisiana, a $3 billion foundation that would focus on poverty and health equity. Under the terms of their agreement, proceeds from the acquisition would be divided between the foundation and policyholders, another concern among Blue Cross members.
  
  Lawmakers also were perturbed by a provision that restricted donations from the foundation for healthcare research to Pennington Biomedical Research in Baton Rouge. The organizations said state governor Jeff Landry required the stipulation but did not disclose why Landry, who technically has no regulatory oversight over the agreement and said in a recent speech that he would not take a position on the sale, requested the provision.




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• Voting process: The deal required yes votes from about 95,000 (two-thirds) of the total 1.9 million Blue Cross customers. Blue Cross acknowledged that the outside organization counting the votes was also calling and soliciting Blue Cross members to vote, raising concerns about undue pressure and bias in favor of the sale.
  
  “The same group that can take a proxy vote over the phone is the same group calling to say, ‘Did you get your ballot?’” said Republican Sen. Thomas Pressly of Shreveport. “I am blown away.”


• Elevance violations: Since 2019, Elevance has incurred 22 fines in seven states that add up to $26.1 million in total, according to the report. Among its violations are coverage denials for necessary care, failure to insure preventive services such as breast cancer screenings, and failure to pay claims on time.

This includes Louisiana, where it was fined $250,000 due to the pharmacy benefits manager of its Healthy Blue Louisiana Medicaid plan referring enrollees to certain providers, a violation of its contract with the state. It also incurred a $1.2 million fine for not meeting quality performance measures, including not following up with patients after they were discharged from hospitals.

San Diego-based healthcare consultant Nate Kauffman, who was not involved in the sale, told Nola.com that there is a "reasonably good chance" that Elevance would try to make the sale work again, saying that its "scale and administrative costs are so much lower than Blue Cross, it is likely they will make a windfall over time by taking over that book of business."

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