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A big Obamacare shoe just dropped in Ohio.
Health insurer Anthem said Tuesday it will effectively exit its Obamacare individual plan business in Ohio, leaving potentially 18 counties in the Buckeye State with no insurer selling plans in 2018.
Anthem, which sells Obamacare plans in 14 states this year, left open the door to dropping out of other states next year.
The company this year sold individual health plans in all 88 counties in Ohio, the only Obamacare insurer to cover the whole state.
But next year, Anthem said, it will sell just a single plan in Pike County, and that will only be available outside of the Obamacare federal marketplace, HealthCare.gov.
There are 10,500 current Anthem customers in the 18 counties who are currently not expected to have an Obamacare plan available as a result of Anthem's planned exit, which was revealed a day after the deadline for filing proposed rates in Ohio for next year.
The company, in explaining what it called "a difficult decision," pointed to continued "volatility" in the individual health plan market, as well as to uncertainty about whether President Donald Trump and the Republican-controlled Congress will continue paying insurers reimbursements for key Obamacare subsidies that reduce low-income customers' out-of-pocket health costs.
The company also blamed the restoration of a tax on insurers.
"An increasing lack of overall predictability simply does not provide a sustainable path forward to provide affordable plan choices for consumers," said Anthem.
"As the Individual marketplace continues to evolve, Anthem will continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future," the company said.
"We participated in [Obamacare] exchanges in all of our 14 states this year," an Anthem spokeswoman said. "Regulations and deadlines for making the decisions regarding our participation vary by state and we intend to continue our dialog with regulators in our markets until that time."
The Ohio Department of Insurance said there were 17 companies selling Obamacare plans in the state through the federal marketplace HealthCare.gov in 2016. That dropped to just 11 companies this year.
Anthem currently is the only Obamacare insurer in the state's 20 counties that have just one insurer. The insurance department said that based on preliminary rate filings for 2018 Anthem's pullback across the state will leave at least 18 counties with no Obamacare insurer next year.
"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," said Chris Brock, a spokesman for the state's insurance department.
"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."
"The Department of Insurance is looking for options to help the approximately 10,500 Ohioans in counties where there may not be an exchange plan when this takes effect in 2018," Brock said.
Anthem will continue selling small-group and large-group health plans in Ohio, which currently cover about 3.4 million people.
Alleigh Marré, spokeswoman for the U.S. Department of Health and Human Services, said "This news is heartbreaking for the millions of Ohioans who depend on access to affordable, high-quality healthcare, and this is a stark reminder that Obamacare is collapsing."
"Now is the time to advance real healthcare reform that empowers individuals and families with the choices and resources they need to buy a plan that meets their healthcare needs without breaking their budgets." Marré said. "The American people can't afford to wait any longer."
Katherine Hempstead, senior advisor at the Robert Wood Johnson Foundation, said, "The things that Anthem does are very consequential because in a lot of the markets where they are they're the only carrier or one of two, so they have a really big footprint and a really important footprint."
Hempstead said that Anthem in recent years has more like local Blue Cross operators, maintaining a stronger commitment to the Obamacare exchanges, compared with its national peers like Aetna and Humana, which each announced a big pullback from the exchanges for 2018 earlier this year.
"I'm a little bit surprised at the Ohio decision," Hempstead said.
In an analysis earlier this year, Hempstead wrote, "Anthem is the most significant [Obamacare] marketplace participant. "
"With plans in 14 states, an Anthem exit would leave nearly 300 counties and about a quarter of a million marketplace enrollees with no carrier, mostly in Georgia, Missouri, and Kentucky," she wrote. "An additional half million consumers residing in 227 other counties would find themselves with only one carrier."
U.S. Sen. Rob Portman, R-Ohio, in a prepared statement said, "For the past few years we've seen premiums and deductibles skyrocket because of the Obamacare law, as we've seen a declining number of viable health care choices for families and small businesses."
"Now, with the pullout of Anthem in Ohio, there are at least 20 counties without a single insurer offering health coverage on the Obamacare exchange," Portman said. "And many other counties will have only one insurer, with no competition to get costs down for families. This is a problem not just in Ohio but across the country. Approximately one-third of the counties around the United States now only have one insurer, and more and more counties are seeing their last insurer leave just like those in Ohio."
"Without true competition and choice in the market, we will never be able to lower health care costs for families and small businesses. This is one more reason why the status quo on health care is unsustainable. The Affordable Care Act has failed to meet the promises that were made to Ohio families," he said.
But Tom Perez, chairman of the Democratic National Committee, said Anthem's departure is the result of Trump's "sabotage" of Obamacare.
"Democrats believe health care is a right for all. That's why we're fighting every day to protect health care for families in Ohio and across the country," Perez said. "More than 664,000 previously uninsured Ohioans have gained access to affordable health care under Obamacare, and as many as 5 million people with pre-existing conditions could have been denied coverage before the law went into effect. Now, because of Donald Trump and Republicans' efforts to sabotage health insurance markets and play games with the lives of the American people, thousands of families in up to 20 Ohio counties will lose their health insurance."