With Blue KC out of Obamacare, attention turns to Medica and Cigna

May 26--Blue Cross and Blue Shield of Kansas City is leaving the Affordable Care Act, commonly called Obamacare, in 2018. So now what? Well, on the Kansas side of the metro, all eyes turn to Medica. On the Missouri side, the key player now is Cigna.

Those are the last two health insurers selling Affordable Care Act plans -- with the accompanying federal subsidies -- to individuals who live in the Kansas City area. If they get out, there will be no subsidized options for consumers who don't get their insurance from an employer or the government.

Even if those two insurers stay in the market they won't be able to fully fill the void Blue KC is leaving unless Medica increases its enrollment cap and Cigna expands its geographic area.

When open enrollment for 2017 insurance began last fall, Kansas City residents on the Missouri side could choose from three insurers: Humana, Cigna and Blue KC.

But Humana announced in February it was leaving all ACA exchanges nationwide after a federal court denied a proposed merger between it and Aetna. Blue KC cited $100 million in financial losses in three years in its exit announcement Wednesday.

Cigna has not given any indication of its plans for 2018, and does not have to make initial filings to the Missouri Department of Insurance until July. The department then has to approve plan designs and premium rates, and plans aren't usually locked in until September.

"Our participation in individual markets is contingent on market conditions and regulatory approval," Cigna spokesman Joe Mondy said via email. "This timing is generally aligned with the start of the open enrollment period. We will be happy to discuss our plans at the end of that process."

Charlie Shields, the president and CEO of Truman Medical Center, said "there's no guarantee" that Cigna will continue on the exchange in 2018.

"It's pretty safe to say you could end up with obviously a greatly diminished number of insurance companies in the exchanges or even end up with no companies in the exchanges," Shields said.

Shields said his hospital has about 3,500 patients it sees regularly who purchase their insurance on the exchange.

Cigna now serves five counties in the Kansas City area on the exchange: Jackson, Platte, Ray, Cass and Clay.

Blue KC serves a much wider swath of northwest Missouri and its exit means that unless Cigna or another insurer expands into their area, these 25 counties will be left without any subsidized options in 2018: Andrew, Atchison, Bates, Benton, Buchanan, Caldwell, Carroll, Clinton, Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Johnson, Lafayette, Livingston, Mercer, Nodaway, Pettis, Saint Clair, Saline, Vernon and Worth.

According to federal data, 20,468 Missourians in those 25 counties purchased health insurance on the exchange last year.

Kansas more clear

An earlier filing deadline offers more clarity in Kansas. Blue Cross and Blue Shield of Kansas has filed to sell 2018 exchange plans in every county except Johnson and Wyandotte and Medica has filed to sell plans in every county. But both insurers have the option to back out during the rate-setting process.

Medica joined the Affordable Care Act exchange in Kansas last year after the departure of another Minnesota-based insurer, UnitedHealthcare.

But Medica has so far barely dipped its toe into the new market, capping its Affordable Care Act enrollment at 10,000 Kansans. The company would have to expand that if they're going to serve the 32,000 exchange customers in Johnson County and Wyandotte County, which are the two Kansas counties Blue KC is exiting next year.

Medica spokesman Greg Bury said decisions about the enrollment cap haven't been made yet.

"Medica is evaluating the situation in Kansas and we are exploring our options," Bury said via email.

Kansas Insurance Commissioner Ken Selzer said Medica alone is probably not capable of filling Blue KC's footprint.

"It's possible, likely, that Medica could expand but probably not absorb all of it," Selzer said.

He said his department is working to bring another insurer into the mix, but the uncertainty about what's happening in Washington complicates things.

Insurers are worried that the Trump Administration might halt cost-sharing reduction payments that fill in reduced co-pays and deductibles for low-income exchange customers. And they're also waiting to see what changes might be made as Republicans in Congress discuss an Affordable Care Act replacement they're calling the American Health Care Act.

"We're looking to ensure that there's a bridge between the current ACA and what might develop into the AHCA or something similar," Selzer said. "It is clear that the ACA is unsustainable in its current form and big changes need to be made."

Andy Marso: 816-234-4055, @andymarso

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