Dow Briggs, M.D. is the Executive Vice President of Blue Cross and Blue Shield of Alabama.

There are many reasons why Jackson Hospital is struggling, but Blue Cross and Blue Shield of Alabama’s reimbursement is not why it is in bankruptcy.

Despite the misleading claims made by the hospital’s CEO, Jackson Hospital is reimbursed more than fairly. Remember that Blue Cross customers represent less than 25% of Jackson Hospital’s patients. The idea that Jackson Hospital’s slide into bankruptcy — or its potential climb out — rests on the backs of less than one fourth of its patients is not realistic.

In fact, revenue has not been Jackson Hospital’s problem. In a September 2025 meeting, Jackson’s interim management team told Blue Cross that from 2015 to 2023, the hospital’s annual revenue increased more than $122 million, from roughly $199 million to over $321 million — a more than 60% increase.

That’s an average annual increase of more than 7.5%. Even with record revenue in 2022 (the most recent year of available public data), Jackson still recorded a net loss that year of approximately $8.4 million.

Unfortunately, Jackson faltered despite a steady, healthy increase in revenue, and when Jackson struggled, Blue Cross repeatedly came back to the table and helped. We have a great deal of respect for the role the hospital plays in the Montgomery community, and have never treated Jackson Hospital as “just another contract.”

We have increased Jackson’s reimbursement beyond what our standard payment models called for, and we have made cash advances to the hospital to help ensure its viability.

Our decisions were made deliberately, to recognize the hospital’s financial difficulties, and to help preserve access for the community it serves. Our goal has been partnership with the hospital, but our primary responsibility must remain the Alabama employers and families who pay premiums.

Like Alabama families managing their own budgets, we have to stretch our customers’ premium as far as possible. That requires being an efficient administrator, and we are proud that more than 90 cents of every premium dollar goes to pay for patient care.

That is one of the highest healthcare provider payment rates in the country. As healthcare costs continue to increase more than 7% every single year, we must be fair to both our healthcare providers and our customers.

Jackson Hospital does important work for the people it serves. But the reality is that its patient mix does not include the same volume of complex, high-cost cases that larger tertiary hospitals in the River Region manage.

Not every hospital in Alabama receives the same reimbursement — and logically not every hospital should. Hospitals that care for the sickest trauma, cardiac, cancer, or neonatal patients incur significantly higher costs due to specialized staffing, advanced equipment, and complex infrastructure.

Paying all hospitals the same flat rate — regardless of the level and complexity of care delivered — would not be fair to our customers and would dramatically increase health insurance costs for Alabama families and employers.

Our role in the healthcare delivery system means we must negotiate agreements with each of Alabama’s more than 100 hospitals based on objective criteria, including the types of services provided, the complexity of patient needs and the resources required to deliver high quality care.

Payments need to reflect that reality to ensure the entire system remains sustainable. We must also safeguard a system that works for all Alabamians, including the hospitals that shoulder the most complex cases, and the employers and families who pay premiums.

We want Jackson Hospital to succeed. We have demonstrated that very commitment through years of open dialogue. Blue Cross remains ready to work constructively with Jackson Hospital’s leadership, local officials and hospital employees to find solutions that preserve access and protect affordability.

Our objective is the same: a Montgomery where every patient receives the right care at the right place — and where the Alabama healthcare delivery system remains strong for generations to come.