On July 5 Mission Health announced its hospitals and affiliates would drop out of the Blue Cross Blue Shield of North Carolina (BCBSNC) network if a current stalemate in negotiations could not be broken. That same day, BCBSNC launched its own media campaign. Media analysts said the strategy is nothing new to healthcare negotiations, but the public stood a lot to lose. While hospitals would have to treat whoever walks in the door, costs for customers could change dramatically. The hospital had asked the insurer to increase reimbursement rates a few percent to keep up with escalating pharmaceutical prices, rapid technology turnover, and a desire to provide competitive compensation for top talent. Mission’s ultimatum is an attempt to bring BCBSNC back to the table; the default contract would carry terms the hospital said are not financially workable. The insurer, however, is also squeezed for funds. Many healthy people have opted to pay the Obamacare tax/penalty instead of subsidizing lower-premium policies and the associated adverse selection. Unaffordable rates, in turn, are forcing paying families to opt out of treatments, or insurance altogether, further depriving BCBSNC of potential income. BCBSNC had applied to the state to increase premiums an average 22.9 percent this year. After Mission’s announcement, the insurer lowered its request to 14.1 percent.