Axios describes the significant role that Blue Cross Blue Shield plays within the health care system.

President Trump has talked about the spiraling implosion of Affordable Care Act (ACA) or Obamacare but a recent Standard & Poor’s report has found that the “ACA individual market is not in a ‘death spiral.’” 
That said, Axios argues that a key component of this outlook is the significant role that Blue Cross Blue Shield plays within the system, with one expert, Dan Polsky from the University of Pennsylvania, calling the group of insurers as typically “the last man standing.”
The site points out that in five states, the cluster of companies and affiliates are the only insurers being offered in the exchange for this year; in many other states, it is the primary carrier among a very limited offering. 
As such, Axios states that Anthem’s “decision to stay or exit in 2018 will be a bellwether for the marketplaces.” It offers plans as part of the Blue Cross Blue Shield exchange market.
The Standard & Poor’s report which came out last week indicates that the companies improved their business in the 2016 marketplace but admits that “target profitability is still a couple of years away.” 
One example of this improving financial performance is Blue Cross and Blue Shield of Kansas City which was on the verge of becoming profitable through the Obamacare exchange for the first time in 2016.
More money came in than was paid out for claims, but the profit margin was likely not enough to fully cover all administrative expenses, reports the Kansas City Star.
Nevertheless, a spokesperson has admitted that the company has not yet committed to offering plans in 2018 due to “proposed legislative and regulatory changes.”