Anthem Pulling Back on Offering ACA Plans in Nevada - Update

By Anna Wilde Mathews Features Dow Jones Newswires

Anthem Inc. said it would stop selling Affordable Care Act marketplace plans in most of Nevada next year. The move together with the departure of a smaller insurer leaves 14 of the state's counties poised to have no insurer on its exchange.

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The state insurance marketplace, the Silver State Health Insurance Exchange, said that insurers had filed to offer plans only in Clark, Washoe and Nye counties, leaving the remaining, largely rural region without any exchange options for 2018. Around 8,000 people living in the 14 potentially bare counties currently have exchange coverage. Anthem had offered marketplace plans throughout the state this year.

In addition to Anthem, a smaller insurer, Prominence Health Plan, a unit of hospital company Universal Health Services Inc., will leave the Nevada exchange next year; Prominence had been selling marketplace plans in seven counties, including four of those that are now poised to lack exchange insurers.

Anthem's pullback in Nevada follows announcements that it will completely exit the ACA marketplaces in Ohio, Wisconsin and Indiana.

The 14 Nevada counties join an estimated 47 counties in Ohio, Indiana and Missouri that currently appear at risk of having no exchange insurers in 2018, according to the Kaiser Family Foundation, after a series of withdrawal announcements. Still, the situation remains fluid, since other companies may come in to fill the gaps, as has happened in Tennessee and Washington state.

Anthem's latest announcement comes as Senate Republicans are trying to push forward a health overhaul, and insurer exits and rate-increase proposals have become flashpoints in the debate over the bill. Republicans point to them as backing the need for their legislation, while Democrats say the insurers are reacting to the uncertainty created by Republicans -- including questions about the future of federal payments that help with health costs for low-income enrollees, which the Trump administration has threatened to stop.

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Nevada's situation may draw more of the spotlight because its Republican Sen. Dean Heller has said he opposes the Senate bill, which is now being reworked.

Nevada Republican Gov. Brian Sandoval called the insurers' decisions "devastating and unfortunate." He said the state "will pursue all available options to help the individuals and families who will be hurt by this decision....Lack of coverage in rural Nevada will set back the years of work we have done to reduce the uninsured rate throughout our state."

David K. Livingston, the chief executive of Prominence, said the insurer was exiting the exchanges in Nevada and Texas, the two states where it participated, because of the uncertainty around the future of the marketplaces, including the federal cost-sharing subsidy payments and enforcement of the current ACA mandate for individuals to have insurance. "There is not enough clarity on what direction it's going that would allow us to continue to operate," he said.

Echoing comments it previously made around other withdrawals, Anthem said its Nevada decision came as the "individual market remains volatile." The company said that "planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies." Anthem also said it was "pleased that some steps have been taken to address the long-term challenges all health plans serving the Individual market are facing."

Anthem is a major presence in its 14 state exchanges, with nearly 1.6 million people enrolled in its ACA plans, 1.1 million of those bought through the marketplaces. Overall, 302 counties in states including Georgia, Missouri and Ohio currently have only Anthem plans available in their marketplaces, according to the Kaiser foundation. So far, the insurer has filed 2018 ACA plans with regulators in other states, including Virginia, Maine and Connecticut. Anthem has said it is evaluating its ACA plans on a state-by-state basis.

Nevada's exchange said it is drawing two new insurers next year, Centene Corp. and Aetna Inc., both in Washoe County, which includes Reno, and also in Clark and Nye, which comprise one coverage region that includes Las Vegas.

Outside of the marketplace, Nevada consumers trying to buy individual plans in the 14 at-risk counties will likely have just one choice: a bare-bones "catastrophic" plan, which Anthem will sell off-exchange statewide next year, said Heather Korbulic, executive director of the Silver State exchange.

Ms. Korbulic said state officials are exploring various possible solutions, including talking to insurers about filling the coverage gap. One option might be to apply for a federal waiver to alter some aspects of the ACA's typical rules, she said, something that officials in Iowa have done. "This creates a health-care crisis for rural Nevada," she said.

Write to Anna Wilde Mathews at anna.mathews@wsj.com

(END) Dow Jones Newswires

June 28, 2017 21:01 ET (01:01 GMT)