Recent public hearings over the proposed sale of Blue Cross and Blue Shield of Maine to Anthem Insurance brought out at least two things that state regulators might consider as they review the proposal. First, the public is very interested in the future of Blue Cross. Second, it asked excellent questions about the proposal that demand further response.

Rep. John Baldacci called the hearings in Lewiston and Bangor last week to give the public an opportunity to say what it thinks of the planned sale. From the audience’s response, the answer was, Not much. Here are a handful of issues that should be followed as the investigation of the sale proceeds.

How much of the policy that drives decisions over care will be made in Maine? It’s all very good for Anthem to say that insurance company officials will remain in this state to address local concerns; if their orders come from a company based in the Midwest, the local touch is fairly meaningless.

Will Anthem commit to protecting rural network providers, which may have older patients who are more expensive to insure and have fewer alternatives for coverage? Will it similarly reject selective contracting, which requires specialists to practice only at certain facilities?

Under Blue Cross, the money Mainers spent on health insurance stayed in Maine. Regulators should understand how much money would be leaving the state under the new owners and what that might mean in terms of the number of jobs eliminated at Blue Cross.

Why the sales price of only $120 million? Blue Cross assets were estimated at $500 million as recently as 1997 by the health-care public interest group Community Assets Project. Dr. Gordon Smith, executive director of the Maine Medical Association, went further when he spoke as a private citizen during a hearing at that time on Blue Cross for-profit subsidiaries, saying that, “physicians alone have contributed billions since 1939,” the year of the charity’s founding.

The price is particularly important because tied to it is a mandatory charity trust fund Anthem would establish based on the fair market value of Blue Cross, which Anthem currently estimates is between $90 million and $100 million. That cannot be meant to cover in perpetuity the historic charity care and programs carried out by Blue Cross.

Finally, regulators must decide what it means to give up much of the oversight of Blue Cross as its ownership transfers out of state. That’s a hard value to put a price on, but important to health care coverage in Maine.

Anthem, to its credit, seems willing to consider a wide range of issues raised during the last month. Perhaps the most important of these was described a couple of years ago in an order by former Insurance Superintendent Brian Atchinson:

“It must be kept in mind … that the decision whether Blue Cross will provide health coverage on a charitable or commercial basis cannot be based on their perception of the best interests of Blue Cross as an insurance company. For stock insurers, generating income for the owners is the goal, and providing services to customers is the way they accomplish that goal. For nonprofit insurers, by contrast, providing service is the goal, and transacting business in the marketplace — while it is every bit as essential a function as providing customer service is for the commercial insurer — is merely the means by which that goal is accomplished.”

Back in 1938, when Blue Cross was still being formed in Maine, an editorial in the Portland Press-Herald was prescient in pointing out that not only could such an organization protect the middle class from “the hazards of expense caused by illness,” but “has a potent humanitarianism in facilitating the hospitalization of those who, through fear of expense, delay application for hospital admission.” Even then, Blue Cross was being praised for its preventive care possibilities.

Anthem at one time expected to have its formal sales and charitable trust plans submitted in early August. Those plans are now expected in the next few weeks. As company officals put the finishing touches on these plans, it now has heard directly the concerns of Maine residents about major changes to the state’s largest health insurer.

A measure of how well they would respond to Maine customers in the future might be seen in whether their plans take into account this new information provided by the public. Maine will have been forewarned if Anthem fails to fully address these issues now.