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Anthem Leaving Maine ACA Exchange, Citing Volatile Market

Darron Cummings
Associated Press/file
This Dec. 3, 2014, file photo, shows the Anthem logo at the company's corporate headquarters in Indianapolis.

A major insurance company has announced that it's pulling out of Maine’s individual health insurance exchange for 2018.

Anthem cites a volatile market and changing federal guidance about the Affordable Care Act among the reasons for its departure. That leaves about 28,000 people who will need to find a different plan, and just two insurers to choose from.

Anthem spokesman Colin Manning said in a written statement that planning and pricing for the individual marketplace has become increasingly difficult due to a lack of federal guidance and certainty. He specifically pointed to the uncertain future of cost sharing reduction subsidies — federal payments to insurers that help lower the cost of their plans — among the reasons for Anthem’s exit.

But Steve Butterfield of Consumers for Affordable Health Care says the situation could have been avoided.

“I think what it underscores for us is what a self-inflicted wound this is from the administration and from Congress not to take action to stabilize the market before now,” he says.

Anthem had been grabbing an growing share of the individual market in Maine, from 7,000 enrollees in 2014 to more than 28,000 this year — nearly a third of marketplace enrollments.

The company’s departure from the exchange leaves just two players in the game: Community Health Options and Harvard Pilgrim.

“There is research that shows that competition lowers premiums. So while premium rates are set for next year, we do worry about in future years, if there continues to be reduced competition, what that could mean for premiums,” Butterfield says.

In the immediate future, Morgan Hynd of the Maine Health Access Foundation says thousands of people are going to have to switch plans, which may have different coverage areas and doctors in their networks.

“One thing that is of concern is that some people can be auto re-enrolled in their plans. If they don’t do anything, they’re just auto re-enrolled. And if they have an Anthem plan, they can’t auto re-enroll, but they won’t know that unless they go sign into Healthcare.gov and look at their options,” she says.

Consumers will have less time to do that this year. The Trump administration has shortened the enrollment period, which used to run from November through the end of January. The end date is now mid-December — and the administration will also shut down the federal exchange website for 12 hours nearly every Sunday during open enrollment.

Community Health Options has experienced its own turbulence in the ACA marketplace. Maine’s insurance co-op has historically covered the most enrollees in the individual market, but had to freeze enrollment a couple years ago after higher than expected claims led to millions in losses.

But CEO Kevin Lewis says after adjusting payments, the co-op is on stable ground.

“We certainly have capacity to take on additional members and look forward to the opportunity,” he says.

Though Anthem will step away from the exchange, the company didn’t pull up its stakes entirely. In three counties — Aroostook, Hancock and Washington — consumers will be able to purchase Anthem’s gold-level individual plans off the exchange. There are no federal subsidies available for consumers with those plans, however, and Butterfield says there’s a reason for that.

“If Anthem left — or any carrier — left the individual market entirely in Maine, it would be five years before they would be allowed to offer plans in that market segment in Maine again,” he says.

Keeping that toe-hold, Butterfield says, leaves a door open for Anthem to re-enter Maine’s individual insurance exchange earlier, if it should choose to.

Meanwhile, Maine’s superintendent of insurance is urging people who buy insurance on the online   exchange to carefully examine their options.

In a press release, Eric Cioppa says Anthem’s decision to leave the exchange leaves fewer choices.

The superintendent also warns about higher rates, since it’s unclear whether the federal government will continue paying cost sharing reduction subsidies. If those end, silver-level plans may no longer be the best choice.

Cioppa says people should look carefully at all costs associated with plans on the exchange, from premiums, to co-pays, to deductibles.

This story was updated Sept. 28, 2017 at 5:59 a.m. ET.