by Bruce Japsen, JUN 21, 2017

Anthem said it planned to “reduce its 2018 individual plan offerings in Wisconsin and Indiana” after being unable to successfully manage the cost of sick patients signing up for coverage under the Affordable Care Act.

Anthem, which operates under the Blue Cross and Blue Shield brand in 14 states, described the situation in a statement Wednesday as a “difficult one” that followed “dialogue with state leaders and regulators.” The decision comes amid regulatory uncertainty in Washington and a lack of funding for cost-sharing subsidies for millions of Obamacare enrollees in 2018.

Thus far, the areas of the country where Anthem is scaling back are those states that were carried by President Donald Trump in the November election and have political leaders hostile to the ACA. Earlier this month, Anthem said it would scale back its ACA-compliant individual offerings in Ohio.

The president has repeatedly said Obamacare’s individual market is “imploding” but insurers say Trump and the GOP-led Congress aren’t helping matters by refusing to fund cost-sharing reductions that would reduce costs for those enrolled in ACA-compliance plans.

The lack of clarity from the Trump administration and Congress are key reasons insurers say they have to scale back for 2018. Already, Aetna and Humana have announced plans to leave ACA individual markets.

“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 cost sharing reduction subsidies and the restoration of taxes on fully insured coverage,” Anthem said in a statement Wednesday.

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Other nonprofit and mutual Blue Cross and Blue Shield plans remain committed to the individual market under the ACA. Take Health Care Service Corp., for example. HCSC is a mutual insurer owned by policyholders and operates Blue Cross and Blue Shield plans in Illinois, Texas, Oklahoma, New Mexico and Montana. "We've submitted products and rates in all of our states and are working through the process with the hope to return, but no final decisions have been made regarding products or participation," Health Care Service Corp. said in a statement last week.

Blue Cross plans in North Carolina and Florida have also said they are committed to Obamacare, though they may have to raise rates by double-digit percentages if cost-sharing subsidies aren't funded.


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