ASHEVILLE – Mission Health said Thursday it would hold harmless people who get their insurance through the Affordable Care Act despite its contract dispute with Blue Cross Blue Shield NC, but Blue Cross NC turned the proposal down.

Mission's offer would affect the roughly 50,000 people in Western North Carolina who get their insurance via the ACA, commonly called Obamacare.

They are among 260,000 WNC residents insured by Blue Cross NC. Care at hospitals, doctors' offices and other health care providers that are part of Mission will become more expensive for all Blue Cross NC customers if Mission and Blue Cross NC have not agreed to a new contract Oct. 5.

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Care at Mission providers will become "out of network" for those with Blue Cross NC insurance Oct. 5. That means they will not get discounted rates negotiated between Mission and Blue Cross NC and will have to pay higher deductibles, co-payments or other costs in most cases.

Mission's offer would have meant those covered through the ACA would pay the same for using Mission providers as they do now.

"We take our responsibility as Western North Carolina’s only safety net health system incredibly seriously," said Mission President and CEO Dr. Ron Paulus.

Blue Cross NC is the only company offering plans through the ACA in the region. Paulus said Mission made its offer because those covered by the ACA "are among the most vulnerable in our region and have no alternative, so it is our responsibility to ensure that access to health insurance – a life transforming event – remains available to everyone."

People on the ACA have incomes above the federal poverty level, but usually not enough to afford health insurance without government help.

Blue Cross NC said later Thursday it was rejecting Mission's offer because it leaves out WNC residents who are not on the ACA.

"With today’s proposal, Mission Health continues to turn its back on senior citizens, state and county employees, businesses and taxpayers across Western North Carolina," said Blue Cross NC CEO Brad Wilson. "This is unfair to tens of thousands of other members; therefore Blue Cross NC has no choice but to reject this offer."

Paulus said in an interview he was "dumbfounded" that Blue Cross NC did not go along. He said Mission officials had hoped the partial concession might prompt Blue Cross NC to resume contract talks with Mission.

"We really thought we were doing a very good thing and we thought since we were meeting Blue Cross' demand for no (rate) increase that they would be delighted," he said.

"If Blue Cross sticks to its current position – which I'm hoping and praying that it won't – that seems like a very unfortunate thing to do to that group of people," Paulus said, referring to Blue Cross NC customers on the ACA.

He said Mission cannot offer in-network rates for non-emergency care without Blue Cross NC's cooperation for legal reasons and because it is not privy to the terms of patients' insurance policies.

Many people covered by the ACA will probably qualify for reduced or free care from Mission because they have low incomes, he said.

The dispute does not affect what Blue Cross NC customers will pay for emergency care. The insurer considers emergency care in-network, meaning customers' share of the cost is less.

Mission Health notified Blue Cross NC July 5 that it was terminating its contract as of Oct. 5. It said Blue Cross NC has refused to agree to a new contract that would contain increases in Mission's reimbursement rates for treating those with Blue Cross NC insurance.

Blue Cross NC says it wants a one-year pause in rising health care costs and will not negotiate a new contract until Mission rescinds its July 5 notice. Other hospitals have agreed to deals like that offered to Mission, Blue Cross NC says.

Mission says the rates it charges Blue Cross NC would have been frozen indefinitely had it not issued the notice and that Blue Cross NC continues to raise the amount it charges for insurance while it demands no increase from providers.

Both sides have been engaged in public relations campaigns intended to convince WNC residents, particularly those who make decisions about buying insurance, of the justice of their respective positions.