Anthem Says It Will Stop Offering ACA Plans in Two States as Others Raise Their Bets -- 2nd Update

By Anna Wilde MathewsFeaturesDow Jones Newswires

Highlighting the continued uncertainty around the Affordable Care Act marketplaces, insurers announced major changes to their offerings for next year, including pullbacks that potentially leave more counties without exchange plans.

Anthem Inc. said it will exit the marketplaces in Wisconsin and Indiana next year, while nonprofit MDwise said it too would leave the Indiana exchange. Those moves may leave four Indiana counties at risk of having no exchange insurers in 2018, according to the Kaiser Family Foundation, though its researchers cautioned the outlook remains unclear. An estimated 44 counties in Ohio, Washington and Missouri will likely face a similar situation.

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The companies' announcements came on the day insurers had to make filings signaling their intentions to offer 2018 exchange plans. A smaller but high-profile company, Oscar Insurance Corp., said it was planning to expand its exchange offerings to include regions within a half-dozen states.

Other major insurers -- Health Care Service Corp., Highmark Health, Kaiser Permanente, and Molina Healthcare Inc. -- said this week that they were filing applications to participate in all of their current marketplace states. But Health Care Service and Highmark both quickly cautioned that they hadn't made final decisions.

Initial federal applications to offer 2018 marketplace plans were due Wednesday for insurers in the 39 states that rely on some aspect of the federal exchange Despite the deadline, insurers have until late September to make their ultimate calls about marketplace plans.

Together, the announcements showed the fluid situation in the health law's marketplaces, with insurers placing different bets amid the uncertainty. Senate Republicans are pushing for fast passage of a health bill, a version of which has passed the House. Insurers say they are unsure about federal payments that help reduce health-care costs for low-income ACA enrollees, which the Trump administration has threatened to halt. Some insurers also have raised concerns about enforcement of the current health law's coverage mandate, which likely won't be enforced under any Republican health overhaul.

Anthem cited a volatile insurance market in its latest pullback announcement, and it said that planning and pricing for ACA 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 around the cost-sharing payments. The company previously said it would stop selling marketplace plans in Ohio next year.

Anthem said it will continue to offer individual plans outside the exchanges in one Wisconsin county, Menominee, and five Indiana counties.

The insurer 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.

The new announcements, as with other recent insurer decisions, will likely be quickly seized on by both sides of the debate over the Republican health overhaul. House Speaker Paul Ryan of Wisconsin blamed Anthem's move on the ACA, also known as Obamacare, and said the 2010 law "has failed our state." Democrats have argued that the markets would be poised to stabilize, but Republicans are hurting the marketplaces by failing to provide insurers with clear answers on key questions like the cost-sharing payments.

A growing number of insurers have said they will pull back or exit the exchanges completely next year. Anthem's decision in Wisconsin didn't immediately appear to leave any counties without 2018 exchange insurers, according to the Kaiser foundation. The four Indiana counties that might be bare of exchange insurers next year are Grant, Wayne, Posey, and Warrick, Kaiser said, though it is possible another insurer intends to enter those counties.

Insurers around the country also have been requesting sharp rate increases, in many cases of 20% or more, for next year's ACA plans, pointing to a combination of market factors and federal uncertainty.

Mdwise, which mostly focuses on Medicaid, said it was leaving the Indiana exchange because fewer Medicaid enrollees than it expected had moved to the marketplace, and it also referred to the "growing uncertainty over the future of the federally subsidized exchange."

On the other side, Oscar said it aims to begin selling ACA plans in Tennessee for the first time in 2018, and re-enter the exchange in New Jersey, where it sat out this year. The insurer also will expand the regions where it sells ACA plans in California and Texas, and will continue selling plans in its home market of New York. Last week, Oscar said it will begin selling marketplace plans in Ohio next year, working with the Cleveland Clinic.

Oscar's CEO, Mario Schlosser, said he believed the marketplaces will stabilize, and the "apocalyptic scenario...just won't come to pass, not this year, and not in the future."

Oscar has been under a spotlight partly because of its tie to the Trump administration: Josh Kushner, brother of Jared Kushner, President Donald Trump's son-in-law and senior adviser, is a co-founder of the startup. According to his financial-disclosure forms, Jared Kushner has divested his interest in Thrive Capital, his brother's investment firm, which is a major Oscar shareholder.

Oscar joins Centene Corp., a large insurer primarily focused on Medicaid, in choosing to expand a commitment to the marketplaces. Centene has said it will begin selling exchange plans in three new states next year and increase the area where it sells ACA plans in six more states. Centene is entering Missouri and expanding in Indiana, Ohio and Washington, but it isn't yet clear if it might fill counties potentially left bare in those states.

Health Care Service said it was submitting filings for products in all five states where it now offers plans under the health law. However, "there's a lot of regulatory and legislative uncertainty concerning the 2018 individual market, and no final decisions have been made at this time," said Kurt Kossen, a senior vice president.

Highmark said it is submitting filings to offer plans in its three exchange states, Pennsylvania, West Virginia and Delaware, but it will make final participation decisions in late September. "We need stability in the market with, at minimum, continued commitment to [federal cost sharing payments] and the individual mandate," said Highmark Senior Vice President Alexis Miller.

--Rebecca Ballhaus contributed to this article.

Write to Anna Wilde Mathews at

(END) Dow Jones Newswires

June 21, 2017 19:06 ET (23:06 GMT)