Without Anthem, many Missouri consumers would have no options on insurance exchange

May 01--Anthem, a long-standing participant in selling health insurance on the Affordable Care Act marketplaces in Missouri, suggested in calls to analysts last week that its participation beyond this year is uncertain.

If Anthem decides to walk, a huge swath of the state would be left without any insurance carrier on the exchange, also known as HealthCare.gov, in 2018.

The health insurance exchange is an online marketplace where individuals can shop for health coverage, a key piece of former President Barack Obama's landmark health care law.

Most individuals are required by law to have health insurance coverage, so Anthem's withdrawal would create uncertainties about what individuals would do in the numerous counties left without an insurance carrier.

In 2017, 244,382 Missourians bought health insurance coverage through HealthCare.gov.

During a call last week with investors, Anthem CEO Joe Swedish said the company, which covers more than 1 million people, would continue to offer plans in markets that were on a "visible path towards sustainability" which includes financial performance.

Swedish did not say which markets were sustainable. Anthem reported better-than-expected revenue and profit during the first quarter of 2017.

In addition, Swedish warned that Anthem may be forced to pull out of markets or raise rates as much as 20 percent if lawmakers decided to pull the funding that reduces the cost of coverage for low-income customers, known as cost-sharing subsidies.

Health insurers, including Anthem, are pressing President Donald Trump and Congress to guarantee the subsidies. Anthem says it needs an assurance of them by early June.

The subsidies are paid directly to insurers, and they help trim out-of-pocket costs like deductibles for customers with low incomes. Nearly 3 in 5 consumers on the exchanges qualify for this help, which totaled about $7 billion this year and is separate from the income-based tax credits people get for their insurance bill.

In Missouri, Anthem has sold health insurance plans through the online exchange since its launch in 2014. Other health insurers have already left the exchanges.

Aetna, which does business as Coventry here, and UnitedHealthcare decided to quit selling exchange plans in 2017. Their departures left 96 of Missouri's 114 counties without an insurance carrier. Exchange plans are separate from coverage obtained through employers. Anthem has no plans to stop providing insurance to employer groups.

Anthem's departure would leave consumers without access to SSM Health facilities. Cigna is the only other carrier that offers exchange plans in the St. Louis area and generally only contracts with BJC HealthCare providers. Meaning if consumers wanted to see any other providers, such as SSM Health doctors, they'd be expected to pay more or all of the cost of care.

Clayton-based Centene Corp. said last week that it is committed to maintaining its presence on the exchange. Centene now covers 1.2 million individuals on the exchange in multiple states and has said it's a profitable business line. But Centene does not sell any exchange plans in its home state of Missouri.

The Associated Press contributed to this report.

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