Anthem Reverses Decision to Pull Out of ACA Exchange in Virginia

By Anna Wilde Mathews Features Dow Jones Newswires

Anthem Inc. agreed to offer Affordable Care Act exchange plans in much of Virginia next year, reversing an earlier decision to withdraw and ensuring that the state won't have any regions lacking marketplace coverage.

Continue Reading Below

The decision is the latest twist in a continuing drama that has played out in states around the country, with state officials repeatedly -- and, so far, successfully -- scrambling to land insurers for potential bare patches on their ACA exchange maps. In addition to Virginia, states including Nevada, Ohio and Tennessee have managed to woo and cajole insurers to come in, after others decided to pull out, often citing uncertainty at the federal level about key aspects of the law.

Last week, Virginia officials said that 48 counties, 15 stand-alone cities and parts of a half-dozen more counties were at risk of lacking exchange insurers in 2018 after small insurer Optima Health announced it would scale back its planned coverage area. That decision came after major national insurers Anthem, UnitedHealth Group Inc. and Aetna Inc. had disclosed plans to leave the state's exchange entirely next year.

But earlier this week, Optima slightly expanded the area where it will sell exchange products next year, and Anthem on Friday announced it would keep selling marketplace plans in 68 cities and counties in Virginia, 63 of which had appeared at risk of lacking a marketplace insurer. Anthem said in a statement that since it learned of the regions that would lack marketplace plans, it "has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in the state" and that "as a result of the ongoing discussions," it agreed to change its withdrawal decision.

Virginia Gov. Terry McAuliffe, a Democrat, said in a statement that Anthem's "decision to make sure every locality in Virginia is served is a recognition that all Virginians need access to health care and a direct reflection of the intense effort by our administration, our Senators Mark Warner and Tim Kaine and our entire congressional delegation to convince Anthem of the value of continuing to offer plans in these localities."

Anthem, which has been a major exchange insurer in 14 states, has already announced it is exiting exchanges next year in four of them. Including Virginia, it is now planning to pull back in an additional five. It has also said it may leave the marketplace in another state, Maine.

Continue Reading Below

Like other insurers, Anthem has flagged lack of clarity about key aspects of the ACA at the federal level as a reason for its decisions, including the uncertain fate of federal payments that are used to lower health-care costs for low-income ACA enrollees.

The Trump administration has threatened to halt these cost-sharing payments. Currently, some members of Congress are pushing legislation that would ensure they are funded, but it isn't clear whether a bill can pass in time to affect insurers in 2018.

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

(END) Dow Jones Newswires

September 15, 2017 15:36 ET (19:36 GMT)