Anthem, Health Tradition pulling out of exchanges while others plan to stay

Anthem and Health Tradition Health Plan have decided to pull out of the individual marketplace in Wisconsin next year, but at least seven other companies said they filed applications with the feds to remain on the exchanges in 2018.

Still, several of those insurers say they’re facing significant uncertainties heading into the next open enrollment period. The filings also aren’t a definitive statement that they’ll offer plans next year, as they could decide against staying on the marketplace in the coming weeks.

Gov. Scott Walker and other Republicans seized on the announcement from Anthem, with the guv saying it’s another sign that “Obamacare is collapsing.” Democrats, meanwhile, said Republicans are sabotaging the marketplace and refusing to work with Democrats on addressing any issues with the Affordable Care Act.

In announcing its exit yesterday, Anthem said the uncertain marketplace has made it “increasingly difficult” for insurers to price their products.

And Health Tradition Health Plan, based in Onalaska, said it is leaving the marketplace “due to financial risk and uncertainty” about the future of the Affordable Care Act.

Of the 15 Wisconsin insurers currently participating in exchanges, only Anthem and Health Tradition have said they are out for 2018. Seven said they are planning on participating in 2018: Medica Health Plans of Wisconsin; Network Health Plan; Security Health Plan of Wisconsin Inc.; Aspirus Arise Health Plan of Wisconsin Inc.; Group Health Cooperative of South Central Wisconsin; MercyCare HMO Inc.; and Dean Health Plan.

Six insurers did not respond to requests for information: Common Ground Healthcare Cooperative; Molina Healthcare of Wisconsin Inc.; Children’s Community Health Plan; HealthPartners Insurance Company; Gundersen Health Plan Inc.; and Unity Health Plans Insurance Corporation.

Other insurers could also decide to enter or come back to the marketplace.

JP Wieske, the state’s deputy commissioner of insurance, said the insurers’ decisions show the “individual market is not stable” in Wisconsin, despite it having the most competition this year with 15 insurers participating in exchanges.

“This market is broken, it’s not working and we need to do something,” he said.

Several insurers, though, said they are planning on coming back to the exchanges for now and filed an application with the Center for Medicare and Medicaid Services to let them participate.

“There’s certainly uncertainty and we have some trepidation in continuing on with that uncertainty,” said Marty Anderson, the chief marketing officer at Security Health Plan.

Anderson and other insurance execs raised concerns over the Trump administration’s possible elimination of cost-sharing subsidies for eligible consumers.

Under the ACA, insurers must offer silver marketplace plans with reduced cost-sharing to enrollees with incomes that are 100 to 250 percent of the poverty level. Within that range, those with lower incomes get a higher percentage of their costs covered.

Penny Ransom, the chief administrative officer at Network Health, said her company is planning on several scenarios right now and that she hopes “some of the big questions are answered” by the time insurers have to make a final decision on whether they’ll be on the exchanges.

“We’re supposed to be preparing our rate submissions, and we don’t know whether or not they will be enforced,” she said.

Wieske declined to say whether OCI thinks the Trump administration should fund those cost-sharing subsidies going forward, though he said insurers always look for predictability and that any uncertainty “creates issues.”

He said OCI officials hope Congress approves an ACA replacement soon — whether it’s the American Health Care Act that passed the GOP-led House or the bill that Republican senators are working on. The approach Republicans are taking, Wieske said, is positive because it shifts control back to the states.

“We’re hoping for action at the federal level so we can move forward,” he said.

The announcement from Anthem and Health Tradition affects the roughly 23,000 people that the two companies cover in the individual marketplace.

Anthem covers about 14,000 people through the individual exchanges, while Health Tradition covers about 9,000.

Wieske said OCI will continue to monitor developments in the market and work with insurers to see if any counties would have limited offerings from insurers.

“If we think there are gaps, we’ll certainly work to get those gaps filled and reach out to carriers to see if there’s something that we can do,” he said.

Anthem spokesman Jeff Blunt said yesterday the company made the “difficult decision to reduce” its individual plan offerings next year to one off-exchange plan in Menominee County, where participation from insurers is lower than other parts of the state.

He said the feds have taken some steps to stabilize the marketplaces, such as revisions to the risk adjustment formula for insurers.

But that hasn’t been enough, he said, particularly as Republicans weigh whether they’ll eliminate some Obamacare cost-sharing subsidies for eligible consumers.

“The Wisconsin individual market remains volatile, making planning and pricing for ACA-compliant health plans increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage,” he said.

He said Anthem’s decision doesn’t affect grandfathered plans, as well as its employer-based insurance options and its Medicare Advantage and Medicaid plans.

“As the Wisconsin Individual market continues to evolve, Anthem will continue to advocate solutions that will stabilize the market to allow us to return and offer consumers in Wisconsin Individual health plan solutions in the future,” he said.

In an email, Blunt declined to say why Anthem is staying in Menominee County for its off-exchange plan. But he said “offering in one county allows us to maintain state eligibility requirements to re-enter the individual market should it stabilize in the coming year.”

“We hope to do so,” he said.

See statements from Anthem and Health Tradition below.


Health Tradition:

–By Polo Rocha and Alex Moe