Another health insurer will quit the Obamacare marketplace next year, leaving 19,000 Obamacare enrollees with no options in 2018.

Blue Cross Blue Shield of Kansas City announced Wednesday that it will not sell coverage on the Obamacare marketplaces next year. The plan has experienced significant losses in recent years and is scared off by the current uncertainty over the health law’s future.

“Like many other health insurers across the country, we have been faced with challenges in this market,” Blue KC chief executive Danette Wilson said in a statement. “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.”

Blue KC currently sells coverage in 32 counties in both Kansas and Missouri. Its exit will hit Missouri hardest, however, because it will leave 25 counties in the Western part of the state with no Obamacare insurers.

Cynthia Cox with the Kaiser Family Foundation estimates that the area has about 19,000 Obamacare enrollees.

The Affordable Care Act doesn’t have a back-up plan for this situation. There is nothing in the law that compels health insurance plans to participate in the marketplaces. States can take action to increase participation. Nevada, for example, requires health insurers who want to bid on Medicaid contracts to sell marketplace coverage, too.

It’s possible that another health plan could sign up to sell coverage in the area. This scenario recently played out in Tennessee: After Humana’s exit from Obamacare left 16 counties surrounding Knoxville with no health plans, Blue Cross Blue Shield of Tennessee decided it would cover that area.

But it’s also possible that no insurer will show up. The nonprofit Blue plans have, so far, been the marketplaces’ backbone. They tend to be the insurers who turn up to sell coverage in the areas no for-profit insurer wants. The fact that it’s the Blue Cross plan quitting the Missouri market and leaving parts of it bare is a worrisome sign for the state, suggesting there are fewer health plans left to save the day.

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