- Anthem announced Tuesday it is pulling out of the Affordable Care Act (ACA) exchange market in Ohio, leaving 18 counties with no plan options in the exchange next year, according to The Wall Street Journal.
- In an effort to prevent a similar issue in his state, New York Gov. Andrew Cuomo ordered the health department to prevent any payers that leave the New York exchange market from participating in other state programs like Medicaid, WSJ also reported.
- Meanwhile, the White House and Congress have been silent regarding the issue nearly all major payers say is causing them to withdraw from the exchanges: a lack of cost-sharing reduction (CSR) payments.
Ohio joins Missouri and Nebraska as states with at least some residents who are expected to have no choices in ACA plans next year. The Anthem announcement isn’t much of a surprise, as other payers have been making similar decisions almost daily. They face a deadline in only a few weeks for determining exchange participation and rate requests.
Ohio, however, had one of the most competitive marketplaces last year. This move from Anthem might be signaling the company’s low tolerance for risk in deciding whether to stay in other state exchanges.
Anthem said in a statement one of the main reasons for its exit is “increasing lack of overall predictability,” such as whether the CSR payments will continue. Many payers have said the exchange markets are not inherently unstable, and they want to offer plans on the exchanges. However, without assurance on CSRs, it isn’t feasible financially.
Insurers who are remaining in the exchanges have said states should expect major rate increases, unless the CSRs are funded.
Cuomo’s move puts pressure on payers in New York, who would stand to lose substantial revenue if they are shut out from programs like Medicaid.