Anthem CEO Joseph Swedish indicated in the health insurance giant's Q4 2016 earnings report that how its participation will proceed with the ACA exchanges after this year would depend on changes made by Congress to the federal healthcare law.
Swedish argued the ACA's individual market "has not been working well," according to an Axios report.
- The company has lobbied for repealing the (currently suspended) health insurance tax, for reduced restrictions on pre-ACA health plans, fewer exemptions for special enrollments, and more stringent rules against patient steering, the report adds.
As one of the last remaining large payers in the nation with a significant footprint in the ACA exchanges, whatever decision Anthem makes will have an immense impact on the exchanges' stability. However, as is likely the case with most payers offering plans on ACA exchanges, Anthem is uncertain how to plan for the future as Congress weighs its options with healthcare reform. “If we can’t see stability going into 2018, with respect to either pricing, product, or the overall rules of engagement, then we will begin making some very conscious decisions with respect to extracting ourselves,” Swedish said in a Wednesday conference call.
Anthem isn't the only payer weighing the benefits of selling health plans on ACA exchanges next year. Aetna CEO Mark Bertolini told investors on Tuesday that the company would not return to ACA exchanges it ceased participating in last year and may continue its withdrawal. Aetna announced in August 2016 that it would exit 536 of the 778 counties where it sold health plans.
Anthem is facing an antitrust lawsuit brought on by the Department of Justice last summer to block its pending $54 billion acquisition of Cigna. The other two insurance giants that also faced an antitrust lawsuit filed by the DOJ, Aetna and Humana, recently had their $37 billion merger blocked by the federal judge after Aetna left ACA exchanges as it had reportedly threatened to do if the deal was challenged by the government. While Anthem could use a similar tactic to Aetna's as leverage, Aetna's shareholders recently filed a lawsuit against the company arguing that it failed to asses how profitable the exchanges it left were.