"Anthem Inc.’s decision to quit Ohio’s Obamacare market will leave 13,000 people without any coverage option under the program next year. That number may rise to 300,000 if the health insurer follows suit in the rest of the states where it sells.
Anthem, which currently oversees Affordable Care Act plans for about 1.1 million people in 14 states, is one of the largest of the multistate insurers that hasn’t pulled back sharply from selling individual plans in the ACA. In April, it said it was “assessing our market footprint in 2018,” and on Tuesday the company said it would leave Ohio.
Currently, there are more than 30,000 people with Obamacare plans who are projected not to have an insurer under the program next year, according to data compiled by Bloomberg. An Anthem exit would raise that number to 300,000 people in seven states.
“Planning and pricing for ACA-compliant health plans has become increasingly difficult due to the shrinking individual market as well as continual changes in federal operations, rules and guidance,” Anthem said of its exit from Ohio. “The lack of certainty of funding for cost sharing reduction subsidies, the restoration of taxes on fully insured coverage and, an increasing lack of overall predictability simply does not provide a sustainable path forward to provide affordable plan choices for consumers.”
Anthem’s Ohio exit will leave 20 counties in the state without an Affordable Care Act coverage option in 2018. Blue Cross Blue Shield of Kansas City said last month it will pull out of the exchange in Missouri, leaving 25 bare counties and about 18,500 people without an ACA coverage option. Humana Inc. said earlier this year it would pull out from all 11 states next year where it currently sells ACA plans. Aetna Inc. said in May it would do the same, also announcing plans to abandon the few remaining states where it had been selling ACA coverage. UnitedHealth Group Inc., the largest U.S. insurer, has already exited ACA exchanges in most of the states where it sold plans. Some small and regional insurers have pulled out of states or counties as well.
If Anthem decided to leave the exchanges nationwide, another 310 counties could be without ACA plans in Colorado, Georgia, Kentucky, Missouri, Nevada and Virginia in addition to Ohio, bringing the total number of bare counties to 355. Anthem did file a rate request in Virginia for next year but could still decide not to sell there."
What if They All Pull Out?
As it stands huge portions of Missouri, Georgia, Nevada, and Kentucky may have no insurance. Smaller, but substantial, portions of Virginia, Ohio, and Colorado may have no insurance.
What would happen if the map was half red?
"The Obamacare marketplaces can be thought of as a government-run store. The government gives many customers subsidies, like gift cards, that they can use to buy insurance. But what happens if no companies want to sell their products in the store?
If all the insurers start leaving some stores, consumers there will find their options dwindling, and then their subsidies will become worthless. Most would end up uninsured. The problem could affect as few as dozens of customers — or spread more broadly to affect a substantial fraction of the approximately 11 million people currently enrolled in Obamacare coverage.
The markets created by the Affordable Care Act have always relied on the voluntary participation of private companies. If the government set up the right conditions for the market, the thinking went, insurers would want to jump in. But, as Sarah Kliff at Vox.com has reported, the law contained no real backup plan if that vision didn’t work out.
In theory, the bare market problem shouldn’t be a big worry. The federal government pays a large fraction of Obamacare premiums for most customers, and a single insurer can essentially name its price. Economists like Mr. Garthwaite see the situation as a happy circumstance for an insurance company. Who wouldn’t want a monopoly market where the government pays the bills?
“Why be at zero — why not come in and charge a freaking outrageous price and be the one?” said Jonathan Gruber, a health economist at M.I.T who advised the Obama administration when it was developing the Affordable Care Act. Then he answered his own question: “Many mysteries of life can be answered with the statement: Insurers are bizarrely risk-averse.”
If insurers do all decide to exit a market, no one is exactly sure what will happen next. Some experts have brainstormed about possible workarounds, but all would entail uncharted legal territory.
Officials at Covered California, the California state marketplace, produced a white paper outlining a series of options to fix the problem of so-called bare counties. But the top bullet point for nearly every option was: “Very difficult, if not impossible, to implement for 2018.”
Theory, Practice, Gruber
Jonathan Gruber, a health economist at M.I.T who advised the Obama administration, on Obamacare is back at it with his lies, formed innocuously in the form of a question.
“Why not come in and charge a freaking outrageous price and be the one?” asks Gruber. He knows the answer.
If insurers got to name their price, Anthem would not be requesting a hike in Virginia. Rather, Anthem would state it’s new price in Virgina.
If insurers got to name their price, major portions of at least 15 states would not be down to a single insurer.
Gruber on Voter Stupidity
“Obamacare architect Jonathan Gruber said that lack of transparency was a major part of getting Obamacare passed because ‘the stupidity of the American voter’ would have killed the law if more people knew what was in it,” according to the Caller.
Gruber served as a technical consultant to the Obama administration and is widely recognized as the law’s architect.
But as challenges to the law have surfaced, the administration has sought to distance itself from Gruber, who acknowledged during the panel discussion that the legislation was purposely written in a confusing way to make sure that the Congressional Budget Office did not score the individual mandate as a tax, a part of the law the Supreme Court upheld on the assertion that it was, in fact, a tax.
“This bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies. Okay, so it’s written to do that,” Gruber said.
“In terms of risk rated subsidies, if you had a law which said that healthy people are going to pay in — you made explicit healthy people pay in and sick people get money, it would not have passed… Lack of transparency is a huge political advantage.
“And basically, call it the stupidity of the American voter or whatever, but basically that was really, really, critical to get the thing to pass… Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not,” he said.
The National Review reported in July that Gruber was paid nearly $400,000 to consult with the administration, and that in 2012 he told an audience at a technical management support organization that tax credits were only available in states that set up their own exchanges.
In August, Breitbart News reported that the White House and ranking Congressional Democrats began distancing themselves from Gruber, after a federal appeals court ruled that people who bought their insurance from healthcare exchanges administered by the federal government in 34 states were not eligible for billions of dollars in tax subsidies."
Lies, Deception, Gruber, Obama
We have this tortured mess known as Obamacare thanks to purposeful lies and deception by Gruber and Obama.
Now, thanks to Republican silliness from House Speaker Ryan and Trump with their push for a replacement that no one is happy with, Republicans took sponsorship of the mess.
Mike “Mish” Shedlock