The dominion of Tennessee's largest health insurer is reflected in its headquarters' lofty perch above the city, atop a hill that during the Civil War was lined with Union cannons to repel Confederate troops. BlueCross BlueShield of Tennessee has used its position to establish a similarly firm foothold in the first year of the marketplaces created by the health law. The company sold 88 percent of the plans for Tennessee individuals and families. Only one other insurer, Cigna, bothered to offer policies in Chattanooga, and the premiums were substantially higher than those offered by BlueCross.