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Anthem leaves ACA in Maine amid marketplace volatility

Today is the deadline for insurers to sign qualified health plans announcing their premium rates.

Susan Morse, Senior Editor

Credit: 802PHOTOSINC, <a href="https://commons.wikimedia.org/wiki/File%3APortland_Headlight%2C_Portland_Maine.jpg">via Wikimedia Commons</a>Credit: 802PHOTOSINC, via Wikimedia Commons

Because of the volatility in the marketplace, Anthem has announced it will not offer an individual product in Maine for 2018.

"While we are pleased that some steps have been taken to address the long term challenges all health plans serving the individual market are facing, the market remains volatile," Anthem said by statement. " A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed. 

[Also: Insurance exchange website for consumers will shut down on most Sundays]

"Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including the restoration of the health insurance tax on fully insured coverage and continued uncertainty around the future of cost sharing reduction subsidies.

"As a result, Anthem will not sell individual plans on the health insurance exchange in Maine for 2018. Additionally, Anthem will reduce its current health plan offerings and offer one off-exchange gold-level plan that will only be available in Aroostook, Hancock and Washington Counties. Under Maine's guaranteed renewal law, existing Individual members will be able to renew their current health plan in 2018, but these plans will be offered off exchange and they will not be eligible to receive financial assistance or subsidies."

Anthem's decision does not affect consumers who have employer-based insurance or individuals enrolled in Medicare.

"As the marketplace continues to evolve and adjust to changing regulatory requirements and marketplace conditions, we will reevaluate whether a more robust presence in the exchange is appropriate in the future," Anthem said.

Anthem had also reduced its footprint in Kentucky and Missouri, but reentered the market in Virginia after learning 63 counties would be bare of an insurer.

The announcement comes on the day insurers hit a deadline to sign the qualified health plan agreement for the premium price of their products in the marketplace. Both insurers and states must return final plan lists for certification today.

Rates are reportedly rising nationwide, with insurers saying lack of a guarantee on CSR payments would add 20 percent to premiums.

November 1, the start of open enrollment, is the target date for the Centers for Medicare and Medicaid Services to post all final rate filings on Healthcare.gov. 

Insurers got past one hurdle Tuesday in the temporary withdrawal of a vote on Graham-Cassidy, a bill opposed by most healthcare organizations because it would result in fewer consumers being insured and those with coverage having higher-cost conditions.

"We're relieved that the Senate has turned away from an inherently flawed bill," said Margaret Murray, CEO of the Association for Community Affiliated Plans.

But while the Affordable Care Act lives on, insurers in the market have no clearer signs of stabilization from the federal government than they had months ago when they asked for stability in a continuation of cost-sharing reduction payments.
 
CMS, under Health and Human Services Secretary Tom Price, has added to insurers' uncertainty by shortening the open enrollment period, cutting ACA promotional dollars by 90 percent, reducing the budget for navigators - organizations which help consumers enroll - and in another bombshell this week, announcing Healtcare.gov would be shut down on primetime Sunday mornings in an outage for maintenance lasting from 12 a.m. to noon, except on December 10.

HHS said it is also shutting down the federal exchange during the overnight hours on the first day of open enrollment on Nov. 1.

Open enrollment ends on Dec. 15, representing less than half the time consumers could sign up during the first four years of the exchanges.

Insurers and providers have voiced support to a return to the bipartisan work of the Senate Committee on Health, Education, Labor and Pensions to stabilize the insurance market.

On Wednesday, Republican Senator Cory Gardner of Colorado introduced the Healthcare Tax Relief Act to delay for one year the health insurance tax that's in the Affordable Care Act but has been on hiatus. Insurers say the tax adds about 3 percent to premium rates.

A bipartisan group of 46 lawmakers last week sent a letter to House Speaker Paul Ryan and House Minority Leader Nancy Pelosi urging for a delay or repeal of the tax.
 

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