The sale of CareFirst BlueCross BlueShield is unlikely to produce major positive or negative impacts on consumers or the state generally, according to five independent consultants' reports released yesterday.

The sheaf of reports was ordered by Insurance Commissioner Steven B. Larsen, who is to rule next month on whether the deal is in the public interest. CareFirst wants to convert to for-profit operation and be sold to WellPoint Health Networks Inc. for $1.37 billion.

WellPoint and CareFirst have similar track records on quality and service, one report said. Two other reports offered opposite conclusions on whether the deal would increase prices.

Yet another consultant said a foundation backed by the sale money could be useful, but its contribution would be small relative to the total health costs and needs in the state.

Finally, a consultant said CareFirst's board acted properly in making the decision to sell, but in choosing WellPoint improperly considered factors other than price, including headquarters location and jobs for current CareFirst executives.

CareFirst filed rebuttals to several reports, challenging specific figures and projections more than overall conclusions.

Here's a look at the reports:

Impact on consumers and health care providers - The Delmarva Foundation, a health quality consulting organization in Easton, concluded that "changes in quality of care and services are likely to be minimal, if the conversion proceeds."

Delmarva compared CareFirst's and WellPoint's policies in such areas as approving care, and reviewed state report cards and other indexes of health plan performance. It generally found the WellPoint and CareFirst plans earning similar marks.

"The results of this review indicate few differences between WellPoint Health Networks Inc. as a 'for-profit' health care company and CareFirst Inc., a 'not-for-profit' company," Delmarva wrote. "The immediate impact of the proposed conversion on Maryland stakeholders would be neutral to moderately negative."

The "brunt of the negative changes," the report said, would likely be felt by doctors and hospitals, given WellPoint's track record in California of hard-nosed bargaining over rates.

In a rebuttal filed by CareFirst, Joseph Marabito, a partner in the consulting firm Accenture, argued: "If lower physician reimbursement translates to lower premiums, then health insurance would cost less than it otherwise would have - a positive impact on consumers."

The Delmarva report noted that WellPoint offers a number of lower-premium plans with higher out-of-pocket costs for patients getting care.

"If co-pays and deductibles prevent accessing needed care, the insurance that patients are paying for is essentially illusory," Delmarva said. " ... Such low cost coverage will not only cause the currently uninsured to buy these 'lite' policies but will often siphon off the better-risk individuals from purchasing more comprehensive insurance."

Impact on prices and availability of policies - The Blue Cross plan in Georgia showed no change in pricing trends after WellPoint bought it, said Wakely Consulting Group, an actuarial firm based in Clearwater, Fla.

Wakely said the loss of CareFirst's tax exemption on premiumsand of a discount it received for being an "insurer of last resort" were likely to add 3.7 percent to premiums for individuals and small employers. Large employers would feel little effect, Wakely said. The price increase would likely cause some individuals or employers to drop coverage, it concluded.

Noting that CareFirst gave up the discount and the tax break in last year's legislative session, G. Mark Chaney, chief financial officer, said in a rebuttal statement, "the premium tax exemption will no longer benefit CareFirst regardless of a change in corporate structure."

Another study, by Roger Feldman, Douglas Wholey and Robert Town, faculty members in health policy at the University of Minnesota, drew from a database tracking hundreds of HMOs for the past 15 years.

That study concluded that for-profit HMOs charge lower premiums, by about 4.4 percent on average. "HMOs reduce their premiums immediately by a small but statistically significant amount when they convert to for-profit ownership," it said, "and from that point onward, they resemble HMOs that have always been for-profit."

Potential for a health foundation - If CareFirst is sold, the money paid would go to health foundations or similar purposes in Maryland and other jurisdictions where CareFirst operates.

In other states where such foundations operate, said consulting group LECG LLC, they "have clearly provided new revenue streams for community-based health care interventions."

The foundation would conduct more charitable activity than CareFirst does as a nonprofit. CareFirst's charitable activity, LECG found, ranged between $157,000 and $2.3 million a year - well below the $50 million in annual tax breaks and discounts it has received.

"We believe the record shows CareFirst has steadily retracted from many of the activities that may be considered 'charitable,'" the report said, noting that CareFirst's charitable obligations had not been spelled out in state law or regulations.

"Despite public perceptions, CareFirst is not statutorily obligated to fulfill a role of 'insurer of last resort' in Maryland," LECG said.

But, particularly in a soft economy - with more uninsured and reduced state revenue to pay for health programs - "the foundation assets are not a 'windfall' that will solve all of Maryland's health care priorities in perpetuity," LECG said.

For example, projecting revenue of $40 million a year for the foundation in Maryland - an estimate similar to that used by CareFirst - LECG said the money could be used to provide Medicaid coverage to 17,000 to 32,000 working-poor adults (including federal Medicaid matching funds), or to pay the premiums for 12,075 Marylanders who have difficulty getting insurance because of health problems.

A report last week by the Maryland Health Care Commission put health spending in Maryland - by employers, individuals and government - at $21 billion in 2001. A Census Bureau report estimates the number of uninsured at 600,000.

Actions by CareFirst's board - The board acted properly in deciding to sell, said Jay Angoff, a former Missouri insurance commissioner.

However, Angoff, who criticized the board in a previous report for its approval of executive bonuses he termed excessive, also said the board had not followed proper procedures in choosing WellPoint and negotiating terms of the deal.

"The board may not properly consider headquarters location, management structure, the number of board seats ... or the willingness of a suitor to pay bonuses to executives in evaluating competing bids," he wrote.

"The process followed by CareFirst to date provides no assurance that the price it has resulted in is fair value."

CareFirst defended the process. Jay Smith, an attorney at Piper Rudnick who advised the board, said it had complied with all legal standards.

Stuart Smith of Credit Suisse First Boston, CareFirst's investment banker, said, "The CareFirst auction process was designed and conducted to obtain the highest price for CareFirst."