Axios

Blue Cross and Blue Shield of Kansas City will not sell health plans in the Affordable Care Act individual exchanges next year. CEO Danette Wilson said Wednesday that "the uncertain direction of this market is a barrier to our continued participation." Wilson also cited $100 million of ACA losses in the first three years.

Who this will affect: The 67,000 people who bought a Kansas City Blues plan through the ACA individual marketplace or outside of it, leaving several counties in Missouri with no ACA insurers for 2018.

Why this matters: The lack of clarity from the Trump administration around the ACA's cost-sharing subsidies, with rate-filing deadlines just weeks away, is forcing insurers in several states to bail. And the departure of a Blues plan is important, since those companies often serve as the safety net.

More context: The individual market has had sicker-than-expected enrollees, but states like California and Florida still have maintained stable markets.

Republican leaders are coming to the bleak conclusion they will end summer and begin the fall with no major policy accomplishments. Privately, they realize it's political malpractice to blow at least the first nine months of all-Republican rule, but also realize there's little they can do to avoid the dismal outcome.

In fact, they see the next four months as MORE troublesome than the first four. They're facing terrible budget choices and headlines, the painful effort to re-work the health care Rubik's Cube in the House (presuming it makes it out of the Senate), a series of special-election scares (or losses) — all with scandal-mania as the backdrop.

Health Care Service Corp. — the parent company of the Blue Cross and Blue Shield affiliates in Illinois, Montana, New Mexico, Oklahoma and Texas — recorded an $869 million profit in the first quarter of 2017, according to the company's latest financial documents. That was a $1.3 billion turnaround after HCSC lost $442 million in the first quarter of 2016.

How to interpret this: The Affordable Care Act exchanges in some areas are hurting, but overall are not imploding. Many insurance companies continue to do well (like Florida Blue) or are turning things around (like HCSC). And HCSC carries a lot of weight, since it covers nearly 1.1 million people in ACA plans and is the largest Blue Cross and Blue Shield company after Anthem.

Even though President Trump has said pharmaceutical companies are "getting away with murder," his first budget for the Department of Health and Human Services does nothing to change how prescription drugs are priced.

The budget is usually just a political wish list, which makes it surprising that Trump didn't include ideas he mentioned on the campaign trail, like allowing Medicare to negotiate drug prices. There's also no mention of mandating Medicaid-type rebates for low-income people on Medicare.

What they're saying: "The lack of any mention in the budget makes us question whether this is truly an issue of importance to the administration." — Spencer Perlman, managing partner at Veda Partners