Anthem, a major health insurer, is “leaning toward exiting” many of the areas in which it sells insurance on the Affordable Care Act exchanges, according to Wall Street analysts who met with the company.
The future of the exchanges, where individuals can buy insurance with the help of government subsidies, has been thrown into doubt as companies wait to see whether the Trump administration and Congress will take steps to stabilize the business. The exchanges had already been challenged, as some insurers had stopped offering plans, leaving about a third of counties with only a single insurer offering plans. Insurers are quickly approaching important deadlines to file to sell insurance in states, and speculation has been rampant about whether the number of choices will drop and premiums will increase.
President Trump has said the exchanges will “explode,” undermining confidence that the administration will work to fix them.
In its fourth-quarter earnings call, Anthem chief executive Joseph Swedish said the company would make decisions on whether to “surgically extract ourselves from certain rating regions, or quite frankly even on a larger scale, depending on the stability of the marketplace.”
But Jefferies equity analysts David Windley and David Styblo wrote in a research note that after a meeting with a company executive, they believe the company is “leaning toward exiting a high percentage” of the markets in which it participates, instead of a surgical extraction. They noted that some of the steps the administration has already taken, such as increasing the verification process for special enrollment periods, were “steps in the right direction, but not enough.”
“Management notes that regulatory advocacy needs to progress significantly in the next ‘month or so,’ ” the analysts wrote.
Anthem sells insurance in 14 states and has 839,000 members through the exchanges, according to its most recent earnings call.
Anthem spokeswoman Jill Becher would not say whether the company would continue to participate in the marketplaces.
“We continue to actively pursue policy changes that will help with market stabilization and achieve the common goal of making quality health care more affordable and accessible for all,” Becher said in an email.
If Anthem makes a major pullout, it would only be the most recent insurer to do so. Humana already announced that it would exit the exchange business next year. Aetna’s chief executive diagnosed the market as in a “death spiral” but has not said whether his company will remain in the four states where it sells plans. UnitedHealth Group has already exited most markets.
Insurers have said the administration and Congress could take simple steps to boost their confidence in the market: continued enforcement of the individual mandate and clarity on how the cost-sharing reductions will be funded, which defray the out-of-pocket costs for lower-income people.
Anthem chief executive Swedish spoke to Trump and Secretary of Health and Human Services Tom Price before the GOP health-care bill collapsed. He also sent a letter to Republican legislators raising some issues with the marketplaces but calling for action.