Commercial carriers are trying to weather uncertain times as the government imposes new regulations under health reform. In advance of new rules governing medical loss ratios, Bradley Wilson, the new CEO of Blue Cross and Blue Shield of North Carolina, is leading the way, announcing plans to cut 20 percent of administrative costs before the major portion of health reform kicks in in 2014. Company officials are studying 80 potential opportunities to restructure administrative costs. High unemployment in the Carolinas continues to dictate few new commercial enrollees, but Medicaid enrollment is on the rise. In response, South Carolina is shifting fee-for-service Medicaid members to managed care, and North Carolina is changing its Medicaid pharmacy policies.