Axios

Blue Cross and Blue Shield of North Carolina is asking for a 23% rate hike for individual Affordable Care Act plans. Although the insurer said Thursday it intends to cover all 100 counties, it said its filing "does not guarantee our participation in offering plans."

Between the lines: The insurer says the uncertainty over whether they'll get their ACA cost-sharing payments "drove the majority of the requested increase." If it weren't for that, it says it would have only asked for an 8.8% rate hike.

Why it matters: This suggests that insurers are now beginning to set their rates higher because they don't think they're going to get the ACA payments.

Top executives at Trinity Health heralded to investors this week that hospitalizations at their $16 billion national Catholic hospital system are on the rise, according to a slide deck obtained by Axios. Trinity CEO Dr. Richard Gilfillan and others were presenting at the annual Citi not-for-profit health care conference. An arrow along the slide's Y axis proclaims that when it comes to hospital admissions, "higher is better."

Why this matters: Hospital leaders publicly extol the concept of "value-based care," which includes keeping patients out of the hospital and focusing more on outpatient and preventive care. Experts agree it's better and safer for people to receive care in other settings when appropriate, and fewer inpatient services saves money.

Trinity's slide reveals a "weird disconnect," according to health economist Austin Frakt, but also reveals some truth-telling at a bank conference: Hospitals still want to fill beds with patients as often as they can.

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.