Anthem Blue Cross, which covers more than one-third of Maine residents with an Affordable Care Act (ACA) plan, is leaving Maine’s ACA exchanges in 2018 because of market uncertainty. Anthem’s decision to pull out leaves two options in the ACA market for Maine residents: Community Health Options and Harvard Pilgrim.
Anthem has pulled out or reduced its footprint in the ACA exchanges in nine out of 13 states for 2018.
Wednesday was the last day for health insurers to sign contracts to participate in the federal marketplace next year. All U.S. counties seem to have at least one ACA plan option next year.
As the Wednesday deadline passed, every county is expected to have at least one ACA plan option, according to the Kaiser Family Foundation.
The CMS said, though, there won't be any competition in nearly half of U.S. counties in 2018. Less insurance competition often means higher premiums, so ideally regulators and consumers would prefer more than one ACA plan to keep down rates.
The past six months have seen much activity as state insurance officials working with payers to plug gaps. Over the past six months, Nevada, Missouri, Indiana, Ohio, Virginia, Tennessee, Washington and Wisconsin were all at one point at risk of having counties without an ACA plan option before state officials worked to fill holes with other payers.
Meanwhile, the federal government has not been nearly as supportive of finding solutions to the ACA plan issues. CMS Administrator Seema Verma has publicly criticized the ACA and said consumers will have fewer insurance choices next year, which is “yet another failing report card for the exchanges,” she said.
Insurers like Anthem, Aetna and UnitedHealth have pulled back or out of the ACA exchanges for next year, while payers like Centene and CareSource have stepped up to take their places.
The payer push-and-pull is connected to insurance companies' unease about whether Washington will fund cost-sharing reduction (CSR) payments. President Donald Trump has made CSR payments to insurers this year, but has threatened multiple times to stop the subsidies, which help keep down out-of-pocket costs for lower-income Americans. Without those payments, insurers have threatened rate increases and even pulling out of the exchanges.
Payers also say the uncertainty surrounding future CSR payments has forced them to substantially increase premium rates.
Another issue causing alarm for insurers is the possibility that the Trump Administration may not enforce the individual mandate next year. Payers fear this move will cause younger, healthier people to drop insurance, which would de-stabilize risk pools.
A bipartisan plan for Congress to provide CSR payments in the short term is stalled on Capitol Hill. Eight major healthcare organizations, including the American Medical Association and American Hospital Association, recently sent a letter asking Congress to agree to CSR payments through 2019. Committing to at least two years “would go a long way to bring much-needed stability to the individual market and promote access to more affordable coverage and choices for millions of Americans,” the groups wrote.
Though the plan for Congress to pay CSR payments stalled, the proposal may get a second life after Republican leadership failed to get enough support to pass the Graham-Cassidy ACA repeal bill.