Anthem, one of the nation's largest insurers, has announced it will pull out of Ohio's Affordable Care Act market in 2018, a move that will leave residents in up to 20 counties without any options for buying coverage on the state's exchange next year.
The company's decision is yet another sign of how the Trump administration has managed to destabilize large chunks of the individual insurance landscape without taking direct steps to dismantle Obamacare. According to the Wall Street Journal, Anthem called the market "volatile," and said it was having trouble pricing its plans, which is now “increasingly difficult due to the shrinking individual market as well as continual changes in federal operations, rules and guidance.” It singled out the uncertainty over whether the government would continue paying crucial subsidies, known as cost-sharing reduction payments, that reimburse insurers for limiting out-of-pocket expenses for lower-income customers.
President Trump has threatened to cut off the funding on multiple occasions, and in May his administration asked for an additional three months to decide whether it would continue appealing a lawsuit brought by House Republicans aimed at stopping the payments, which are expected to be worth $7 billion this year. While the government delivered last month's payment, the administration won't commit to continuing them. The indecision has led panicked insurers to request large premium hikes and warn that they might have to leave the market entirely next year if the subsidies dry up. America's Health Insurance Plans, the major industry trade group, has called it "the single most destabilizing factor in the individual market."
As the Kaiser Family Foundation's Cynthia Cox notes on Twitter, the 20 counties where Anthem is currently the only company offering exchange coverage make up a relatively small part of Ohio's insurance market. But with its footprint across 14 states (or 13, after Tuesday), Anthem theoretically could leave hundreds of thousands without insurance options if it were to leave the exchanges nationwide. Here's how Cox sums up the situation.