BCBS exit leaves an “Unhealthy” void

Blue Cross and Blue Shield (BCBS) of Kansas City recently announced that they are withdrawing participation in the 2018 individual marketplace. Unless another insurer enters the individual marketplace, 25 western counties in Missouri will be left without any insurers. Thirty counties in Missouri and two counties in Kansas City, amounting to 67,000 Blue KC members, will be affected.  The graphic above provides details about counties affected.

Of the 25 counties that will be left without an insurance option through the individual marketplace, several counties that are part of GVMH’s service area will be affected.  Johnson, Henry, Pettis, Benton, St. Clair and Bates are among those affected.  The vast majority of residents served by GVMH will not have a marketplace option as of January 1, 2018.

BCBS of Kansas City is leaving the marketplace because they have experienced financial losses since they began offering the plan as a result of the Affordable Care Act in 2014.  Here’s a statement I found on the BCBS website explaining their decision;  “Since 2014, we’ve expended significant resources to offer individual ACA plans to increase access to quality healthcare coverage for the Kansas City community,” said Danette Wilson, President and CEO of Blue KC. “Like many other health insurers across the country, we have been faced with challenges in this market. Through 2016, we have lost more than $100 million. This is unsustainable for our company. We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of this market is a barrier to our continued participation.”

This situation is not unique to Missouri.  Several states have limited or no individual marketplace option because insurers have lost money by participating.  There are several reasons the model hasn’t worked but two stand out.  One, many young, healthy adults have chosen not to pursue coverage through the marketplace.  Insurance requires as many low utilizers as high utilizers to work out.  Two, the subsidy provided by the federal government to help cover the cost of marketplace plans is not enough to cover the insurers loss.

GVMH is committed to providing high quality care to anyone in need regardless of coverage or ability to pay.  Thousands of people within our service area will have no affordable insurance option beginning in 2018 and BCBS’s decision to exit the marketplace puts them at risk.  It’s well documented that individuals without coverage tend to put off health care causing acute problems to become chronic.  Treating chronic illness is more difficult and costly than catching a problem early on and resolving it.

I can understand BCBS’s decision and I appreciate they were willing to take a financial loss as long as they did so I don’t blame them.  Our great country has a health care system problem and there are no easy solutions.  The best we can hope, for residents of Henry and surrounding counties, is that another insurer enters the marketplace by January 1, 2018.  But why would they?

About Craig Thompson

I am a young professional with two great sons, and I work in the healthcare setting. I am employed in hospital administration and serve as Chief Operating Officer at Golden Valley Memorial Healthcare in Clinton, Missouri. These are challenging and exciting times in healthcare and my blog will focus on healthcare, raising boys or being raised by boys, and living in mid America.
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