Blue Cross of Kansas City has announced its withdrawal from Missouri's exchange, a decision that will leave an estimated 19,000 residents in Western Missouri with no coverage option and diminishing the number of exchange based coverage options for a wider group of Kansas City area residents. Business Insider has been calling this "the worst case scenario."
Blue KC's rationale is two fold: business losses sustained since 2014 and insurance market uncertainty.
The Kansas City Star's article about the blame game attempts, I think, to be even handed. "Death spiral" announces Kansas Governor Brownback. The "death by a thousand cuts position" is also discussed, though carefully anonymized when presented.
Make no mistake that it is Missouri and Kansas's decision not to expand Medicaid combined with a continued refusal to fully fund risk corridor payments that has done much to bring us to this impasse.
Senator Roy Blunt's connection of Blue KC's 2018 exchange withdrawal on President Obama's failure to guarantee people could keep the health providers they like is particularly interesting. And those who hadn't had health care providers before the ACA because they were uninsured? Well, Obamacare is apparently taking their access as well.
The blame game is unlikely to end anytime soon, even if the Missouri and Kansas insurance commissioners were inclined and able to persuade another insurer to enter their marketplaces.
But Truman Medical Center knows what this could mean, whatever the point counter-point rhetoric. As the area's safety net hospital whose uncompensated care burden dropped from $134 million to $100 million under the ACA, they know exactly who is behind the eight ball if all those newly uninsured come flooding back.