As Children’s Mercy is dropped by ACA Marketplace, MO insurance group makes statement

A Missouri insurance trade group says rising health care costs are making it harder to keep premiums affordable, after Children’s Mercy announced that ACA Marketplace health plans will no longer include the pediatric hospital as an in-network provider starting Jan. 1.

Missouri families and small businesses are feeling the strain of rising health insurance costs as premiums climb nationwide, the Missouri Insurance Coalition said in a statement on behalf of its member companies participating in the ACA individual market.

“Health insurance cannot become more affordable unless health care itself becomes more affordable,” the nonprofit trade association representing insurance companies doing business in Missouri said.

“Every hospital stay, procedure, and prescription is ultimately paid for through the premiums of Missouri families and employers. Insurers’ rate requests are reviewed by regulators, but no amount of review can hold premiums down for long when the underlying cost of care keeps rising.”

Children’s Mercy announced on Tuesday evening that ACA Marketplace coverage will change on Jan. 1.

“Children’s Mercy wants to participate in the ACA Marketplace networks serving our area,” the pediatric hospital said. “However, the health plans have chosen not to include Children’s Mercy as an in-network provider. This was not a decision made by Children’s Mercy.”

The health system said it was “committed to finding sustainable ways to ensure children have access to the pediatric care they need,” adding that the issue wasn’t unique to Children’s Mercy but part of a broader problem affecting access to health care.

The trade association said that nonprofit hospitals hold a special place in the community. It added that their tax-exempt status brings a responsibility to keep care affordable.

“That responsibility carries extra weight where a single facility is the only realistic option for specialized care across a large region,” the trade group said. “In those cases, reimbursement should reflect the reasonable cost of providing care, not the absence of alternatives.”

The trade association acknowledged Children’s Mercy’s importance in providing specialized pediatric care, but said ACA coverage must remain financially sustainable across Missouri’s health care system.

Those with questions can call Children’s Mercy at 816-302-1650 or visit the group’s website.

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