Anthem, one of the nation’s largest insurers and a major player in the individual insurance market created by the federal health care law, announced Tuesday that it would stop offering policies in the Ohio marketplace next year.
Although its departure would leave a small number of people — roughly 10,500 who live in about a fifth of the state’s counties — without an insurance carrier, the move was seized on by Republicans as more evidence that the markets are “collapsing” under the Affordable Care Act. President Trump, meeting with congressional leaders on Tuesday, said it was more proof that insurers are “fleeing and leaving” the marketplaces and added that it was essential for Congress to pass a bill repealing the health law this summer.
Republican senators said on Tuesday that they were trying to reach agreement on some major issues, especially Medicaid.
Senator John Barrasso, Republican of Wyoming, said that Republican senators spent much of a meeting on Tuesday with Vice President Mike Pence discussing health care. Mr. Barrasso outlined some differences with the bill that passed the House.
The senators want “a smoother glide path, rather than an abrupt cutoff,” of Medicaid expansion funds that the federal government provides in 31 states, he said.
Some senators have also expressed concerns about provisions in the House bill that would allow states to seek waivers from certain federal insurance standards, including one that prohibits companies from charging higher premiums to people with pre-existing conditions. Senate Republicans, however, have not agreed on which provisions could be waived.
Congressional Republicans have said they plan to provide tens of billions of dollars to hold down premiums, stabilize insurance markets and help cover high-cost patients in the next decade. But it is unclear whether an injection of federal money will come soon enough to influence other insurers’ decisions about participating in the marketplaces in 2018.
Besides Ohio, Anthem operates for-profit Blue Cross plans in more than a dozen states. The company said on Tuesday that it had not yet made a decision about its participation in those exchanges, but it and other companies have grown increasingly anxious as efforts by Congress drag on.
Senator Rob Portman, Republican of Ohio, said the exit of insurers was “a problem not just in Ohio but across the country,” and he blamed the existing law for “a declining number of viable health care choices for families and small businesses.”
Democrats countered that the market is shaky because of efforts by the Trump administration and congressional Republicans to undermine the law, including their continued threat to stop providing critical funding to low-income individuals to better afford plans.
“They own this health care system now,” said Senator Sherrod Brown of Ohio. “Because they fiddled for the last five months and injected more uncertainty into the insurance market, premiums have gone up and insurance companies have pulled out.”
Federal and state deadlines are quickly approaching this month for insurers to decide if they will remain in the marketplaces and how to price their plans for 2018.
While Anthem had warned that it might leave some or all of the states where it offers individual plans, its exit from Ohio signals that even some of the market’s stalwarts are unnerved. Aetna and Humana have said they do not plan to participate next year after losing money, but Anthem appeared be turning the corner.
If Anthem were to exit the federal health insurance exchanges entirely, “there could be hundreds of thousands of people without any option on the exchange,” said Cynthia Cox, an executive at the Kaiser Family Foundation.
In the last few weeks, two other Blue Cross companies announced that they were dropping out of exchanges, in Nebraska and in parts of Kansas and Missouri. Iowa’s Blue Cross plan has also said it does not plan to offer plans on the exchange next year.
The exit leaves insurance regulators with the prospect that some of their residents may not be offered a plan in 2018.
“For the past few years we have seen a weakening in the federal insurance marketplace as a number of companies have withdrawn from the exchange,” the Ohio insurance agency said in an email. “We have always argued the private insurance market is the most severely impacted by the federal law and that is where congressional action is needed to restore stability.”
Even when insurers are staying, the uncertainty and concern over the health of people in the market is leading many to file eye-popping rate increases for next year. In Maine, Harvard Pilgrim Health Care is asking for an average price increase of about 40 percent, while Anthem, which warned state regulators that it might have to revisit its plans, depending on what happens, wants a 21-percent increase.
Some state regulators are asking the insurers to file various rates based on what happens, but the different scenarios can lead to much higher rates. In Pennsylvania, Teresa Miller, the state’s insurance commissioner, said in a statement this month that the five carriers had requested an average increase of 9 percent, demonstrating that the market “is stabilizing and insurers are better understanding the markets and the population they serve.”
But the increases could be much higher. Prices would go up by 20 percent if there was no longer funding for subsidies, the regulator said. Rates could also be higher if the Trump administration does not enforce the tax penalty on people without insurance.
Robert Pear and Thomas Kaplan contributed reporting.
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