EDITORIAL: Anthem takes leave of Ohio

June 08--Recall what executives of Anthem Blue Cross and Blue explained in late April. They stressed that the marketplace exchange for purchasing individual health insurance policies was improving, something echoed by Standard & Poor's and the Congressional Budget Office. The executives made clear to states that if insurers did not receive some certainty about the funding of cost-sharing reduction payments, key subsidies for the companies and low-income customers, they would weigh whether to increase dramatically the premiums Anthem charges or cease operating in the exchange.

On Tuesday, Ohio received its notice. Facing a deadline to propose its rates for next year, Anthem announced that it will exit the state. That leaves roughly 10,000 people in 18 counties without an insurance plan. Another 56,000 across the state must find an alternative for health coverage.

The state Department of Insurance fingered the Affordable Care Act as the culprit, citing a "weakening" of the insurance exchange "the past few years." U.S. Rep. Pat Tiberi, a Columbus Republican, echoed the argument of President Trump about how the act is "collapsing under its own weight."

Actually, as the Anthem executives indicated, the problems could be fixed, restoring the "stability" the Insurance Department rightly sees as needed. Those who engineered the exchanges recognized that adjustments and repairs would be required, something so complicated not likely to operate flawlessly. They created financial cushions for insurers, alert to the leap the companies were taking.

One important cushion comes in the form of the cost-sharing reduction payments. The act requires insurers to offer those with low incomes policies that have lower deductibles and co-payments. That helps make the policies more affordable. The federal government then reimburses the insurers for the cost, amounting to $7 billion a year. Anthem and others wanted assurance the payments would be there.

Unfortunately, neither the Trump White House nor the Republican-led Congress has been helpful. As June approached, the administration again played coy, and it still is doing so. In 2014, House Republicans filed a lawsuit seeking to halt the payments, though the judge ruled the payments could continue while the case is pending.

Even a simple declaration from the president that he will stick with the payments until the matter is resolved in the courts or the enactment of a replacement would likely have helped to keep Anthem in the exchange. The Center on Budget and Policy Priorities notes that insurers in North Carolina and Pennsylvania said their rate increases would be one-third or less of last year's -- with a commitment to the cost-sharing reduction payments and stronger enforcement of the individual mandate.

As it is, the uncertainty is too much for companies dependent on forecasts for the long term. So the departure of Anthem from the exchange is less about the flaws in of the law and more about a form of deliberate destruction. The president and Republican allies, still without a responsible replacement, appear determined not to see the Affordable Care Act work but to brand the law a failure.

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