Tag Archives: Affordable Care Act

Trump scraps key Obamacare subsidies, urges Democrats to fix ‘broken mess’

Trump scraps key Obamacare subsidies, urges Democrats to fix 'broken mess'

By Yasmeen Abutaleb and Jeff Mason

WASHINGTON (Reuters) – U.S. President Donald Trump on Friday urged Democrats to make a healthcare deal after cutting off Obamacare subsidies to health insurance companies for low-income patients in a forceful move that sparked threats of legal action and concern of chaos in insurance markets.

“ObamaCare is a broken mess,” Trump tweeted early on Friday. “Piece by piece we will now begin the process of giving America the great HealthCare it deserves!”

The decision is the most dramatic action Trump has taken yet to weaken the Affordable Care Act, President Barack Obama’s signature healthcare law, which extended insurance to 20 million Americans.

The move drew swift condemnation from Democrats and threats from state attorneys general in New York and California to file lawsuits. Trump, a Republican, urged opponents to reach out to him.

“The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!” Trump said in another tweet on Friday.

Trump has been frustrated by Republicans’ failure to repeal and replace the law known as Obamacare, thwarting a promise he made during his successful 2016 presidential campaign.

His decision is likely to please those among his political base who detest the Obamacare system, which many Republicans have attacked for years as an unneeded government intrusion in Americans’ healthcare.

In a nod to that same constituency, the president signed an executive order earlier on Thursday to make it easier for Americans to buy bare-bones health insurance plans exempt from Obamacare requirements.

Senate Democratic Leader Chuck Schumer and House Democratic Leader Nancy Pelosi derided the subsidies cut-off in a joint statement, saying Trump would single-handedly push Americans’ healthcare premiums higher.

“It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”

Insurers and proponents of Obamacare have implored Trump for months to commit to making the payments, which are worth billions of dollars. Several insurers have cited uncertainty over the payments when hiking premiums for 2018 or exiting insurance markets altogether.

Healthcare stocks have edged lower in recent days. Ending the payments could hurt shares of insurers such as Anthem Inc, Molina Healthcare Inc, Cigna Corp and Centene Corp, which are offering plans on Obamacare markets for 2018.

Trump has made the payments, guaranteed to insurers under Obamacare to help lower out-of-pocket medical expenses for low-income consumers, each month since taking office in January. But he has repeatedly threatened to cut them off and disparaged them as a “bailout” for insurance companies.

For Kathryn Haydon and her husband, who bought insurance under the law’s marketplace three years ago as struggling college students in Arkansas, the subsidies reduced the cost of their $310 plan by about $250, leaving them to pay $60 each month.

“If the subsidy was not there, we would have gone without health insurance,” she said. “Our finances were extremely tight at the time for us… we would have just hoped there were no catastrophes.”

LAWSUITS

The White House said late on Thursday that it could not lawfully pay the subsidies anymore.

A White House statement said that based on guidance from the Justice Department, “the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare.”

“In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments,” it said.

New York Attorney General Eric T. Schneiderman said in a statement he was prepared to lead other attorneys general in a lawsuit.

“I will not allow President Trump to once again use New York families as political pawns in his dangerous, partisan campaign to eviscerate the Affordable Care Act at any cost,” he wrote.

The payments are the subject of a lawsuit brought by House Republicans against the Obama administration that alleged they were unlawful because they needed to be appropriated by Congress. A judge for the federal district court for the District of Columbia ruled in favor of the Republicans, and the Obama administration appealed the ruling.

The Trump administration took over the lawsuit and had delayed deciding whether to continue the Obama administration’s appeal or terminate the subsidies, but in April Trump began threatening to stop the payments.

That case became more complicated in August when a U.S. appeals court allowed 16 Democratic state attorneys general to defend the payments and have a say in the legal fight.

The political turbulence has affected insurers’ decisions.

Anthem Inc, one of the largest remaining Obamacare insurers, in August scaled back its offerings in Nevada and Georgia and blamed the moves in part on uncertainty over the payments.

Blue Cross and Blue Shield of North Carolina earlier this year raised premiums by more than 20 percent, but said it would have only raised premiums by about 9 percent if Trump agreed to fund the payments.

The nonpartisan Congressional Budget Office estimated that cutting off the payments would cause premiums to rise 20 percent in 2018, and that 5 percent of Americans would live in areas that do not have an insurer in the individual market in 2018.

Trump has taken other steps to undermine Obamacare. Last week, his administration allowed businesses and non-profit organizations to seek exemptions from Obamacare’s mandate that employers provide birth control in health insurance with no co-payment.

The administration also slashed the Obamacare advertising and outreach budget and halved the open enrollment period.

(Additional reporting by Steve Holland, Brendan O’Brien and Susan Heavey and; Editing by Michael Perry and Bernadette Baum)

Trump expected to sign order side-stepping Obamacare rules

FILE PHOTO: U.S. President Donald Trump calls on Republican Senators to move forward and vote on a healthcare bill to replace the Affordable Care Act, as people negatively affected by the law stand behind him, in the Blue Room of the White House in Washington, U.S., July 24, 2017. REUTERS/Joshua Roberts

By Yasmeen Abutaleb

WASHINGTON (Reuters) – President Donald Trump was expected to sign an executive order on Thursday that would make it easier for Americans to buy bare-bones health insurance plans and circumvent rules put in place by Obamacare, though such an order could face legal challenges.

Stymied in Congress by the failure of Senate Republicans to roll back former President Barack Obama’s 2010 healthcare law, Trump’s executive order would represent his administration’s latest effort to undermine the law without legislation.

The order would allow small businesses and individuals to band together as associations to buy cheaper health plans that would be exempt from some Obamacare requirements. Among the requirements would be the mandate that all health plans cover 10 essential health benefits, including maternity and newborn care, prescription drugs, and mental health and addiction treatment.

The order would also change an Obama-era limit on the time span people can use short-term health insurance plans, which are cheaper but cover few medical benefits. Trump was expected to order an extension for the period that long short-term insurance can be used to about a year, versus three months under Obamacare.

Republicans, despite having control of the White House and both chambers of Congress, have for months been unable to make good on their seven-year promise to repeal Obamacare, which they view as a government intrusion into Americans’ healthcare.

Experts questioned whether Trump has the legal authority to expand association health plans and whether some plans, but not others, could be exempt from Obamacare rules.

The action could open Trump to legal challenges from Democratic state attorneys general, who have said they will sue Trump if he tries to destroy Obamacare, a law that brought health insurance coverage to millions of Americans.

Experts said the association health plans could attract young, healthy people and leave a sicker, more expensive patient pool in the individual insurance markets created under the healthcare law, driving up premiums and effectively eroding the law’s protection for those with pre-existing conditions.

Conservative groups and lawmakers, including Republican Senator Rand Paul, who said he has worked with Trump for months on the expected order, and Republican Senator Ron Johnson, have cheered the expected order. Paul opposed the Senate’s most recent attempt to overhaul Obamacare because he said it left too many of Obamcare’s regulations and spending programs in place.

Trump has taken a number of steps since assuming power in January to weaken or undermine Obamacare. He has not committed to making billions of dollars of payments to insurers guaranteed under Obamacare, prompting many to exit the individual market or hike premiums for 2018.

The administration also halved the open enrollment period, which begins Nov. 1, and slashed the Obamacare advertising and outreach budget.

(Reporting by Yasmeen Abutaleb; Editing by Kevin Drawbaugh and Leslie Adler)

Obamacare repeal in U.S. Senate collapses as Republicans falter

Protesters, mostly handicapped, line the hallway outside the Senate Finance Committee hearing room hours ahead a hearing on the latest Republican effort to repeal Obamacare on Capitol Hill in Washington, U.S., September 25, 2017. REUTERS/Kevin Lamarque

By Susan Cornwell

WASHINGTON (Reuters) – Another Republican attempt to dismantle Obamacare collapsed in the U.S. Congress on Tuesday as the party was unable to win enough support from its own senators for a bill to repeal the healthcare reform law.

Several Republican senators said there will be no vote in the Senate after some lawmakers withheld support for the measure.

“We basically ran out of time,” said Senator Ron Johnson.

Senator Pat Roberts, another Republican, told reporters the party would target healthcare “in some form” later in the current legislative session.

Failing to carry through on a 7-year-old effort to roll back the 2010 healthcare law would be an embarrassing setback for Republicans and a heavy blow for President Donald Trump, who vowed during the 2016 election campaign to scrap Obamacare.

After losing a Senate vote on repealing Obamacare in July,

Republicans tried again this month with a bill that would take

federal money and give it to the states in block grants to regulate their own healthcare systems.

But several Republican senators refused to back the latest bill, including Senator Susan Collins, who on Monday complained that it undermined the Medicaid program for the poor and disabled and weakened protections for people with pre-existing conditions, such as asthma, cancer and diabetes.

Trump said on Tuesday his administration was disappointed in “certain so-called Republicans” who did not support the bill.

Republicans hold a slim 52-48 majority in the Senate and

at least two other Republican senators, John McCain and Rand Paul, had earlier rejected the bill.

Republicans have tried for years to get rid of the Affordable Care Act, or Obamacare, but they were up against a Sept. 30 deadline to pass a bill with a simple majority, or face a much tougher path toward dismantling it.

(Reporting by Susan Cornwell and Richard Cowan; Additional reporting by Susan Heavey; Writing by Alistair Bell; Editing by Kevin Drawbaugh and Bill Trott)

Obamacare repeal on the ropes as pivotal Republican rebuffs Trump

U.S. Senator John McCain (R-AZ) (C) departs after the weekly Republican caucus policy luncheon at the U.S. Capitol in Washington, U.S. September 19, 2017. REUTERS/Jonathan Ernst

By Susan Cornwell and Yasmeen Abutaleb

WASHINGTON (Reuters) – U.S. Senator Susan Collins rebuffed intense lobbying from fellow Republicans and the promise of money for her state in deciding on Monday to oppose – and likely doom – her party’s last-ditch effort to repeal Obamacare.

The most moderate of Republican senators joined John McCain and Rand Paul in rejecting the bill to end Obamacare. It was a major blow for President Donald Trump who has made undoing Democratic former President Barack Obama’s signature healthcare law a top priority since the 2016 campaign and who pressured Collins in a call on Monday.

The bill’s sweeping cut in funding to Medicaid, a program for low income citizens and disabled children, was her top reason for opposing the bill, said Collins, from the state of Maine where 20 percent of the population depend on the program.

“To take a program that has been law for more than 50 years, and make those kinds of fundamental structural changes … and to do so without having in depth hearings to evaluate the impact on our most vulnerable citizens was unacceptable,” Collins said outside the Senate chambers.

She also opposed the bill for weakening protections for people with pre-existing conditions, such as asthma, cancer and diabetes.

Collins’ decision came even after the sponsors of the bill, Senators Lindsey Graham and Bill Cassidy, offered a boost in federal health care funds of 43 percent for Maine and benefits for states with other undecided senators.

Republicans have vowed to get rid of the Affordable Care Act, or Obamacare, since it was passed in 2010. While it extended health insurance to some 20 million Americans, they believe it is an unwarranted and costly government intrusion into healthcare, while also opposing taxes it imposed on the wealthy.

Republicans hold a slim 52-48 majority in the Senate and are up against a tight September 30 deadline to pass a bill with a simple majority, instead of the 60-vote threshold needed for most measures. Senate Majority Leader Mitch McConnell wanted to hold a vote this week, but it is not clear he will do so now that three senators have said they will cast “no” votes.

Graham dismissed notions that the bill was the last chance for Republicans to get rid of Obamacare and pledged to keep working on the legislation.

$1 TRILLION CUT TO MEDICAID

Democrats kept up their pressure for killing the bill. In an evening speech on the Senate floor, Senate Democratic leader Chuck Schumer said, “The Trumpcare bill would gut Medicaid, would cause millions to lose coverage, cause chaos in the marketplace.”

Schumer said once repeal of Obamacare is off the table, Democrats want to work with Republicans “to find a compromise that stabilizes markets, that lowers premiums.”

Collins and McCain, who voted against the last major repeal effort in July, have both advocated for a bipartisan solution to fixing the parts of Obamacare that do not function well.

U.S. hospital stocks were down across the board as the bill struggled. Shares of HCA Healthcare Inc and Tenet Healthcare Corp were hit particularly hard, falling 2.5 percent and 5.7 percent, respectively, on Monday.

“The Graham-Cassidy bill is looking to reduce funding for Medicaid in the longer term,” said Jefferies analyst Brian Tanquilut. “That is a benefit that we have seen improve the earnings outlooks for these hospitals.”

Collins announced her opposition shortly after the non-partisan Congressional Budget Office said that the number of people with health insurance covering high-cost medical events would be slashed by millions if it were to become law.

CBO also found that federal spending on Medicaid would be cut by about $1 trillion from 2017 to 2026 under the Graham-Cassidy proposal, and that millions of people would lose their coverage in the program, mainly from a repeal of federal funding for Obamacare’s Medicaid expansion.

The Trump administration, including Health Secretary Tom Price had lobbied her hard in recent days, Collins said.

“The president called me today, the vice president called me in Maine over the weekend, Secretary Price has called me, it would probably be a shorter list of who hasn’t called me about this bill,” she said.

Trump had not called Collins before the vote in July.

PROTESTERS IN WHEELCHAIRS

The Senate held its first hearing all year on the proposed Obamacare repeal on Monday, but it was immediately disrupted by protesters who forced Senate Finance Committee Chairman Orrin Hatch to postpone its start by about 15 minutes.

Police arrested 181 demonstrators, including 15 in the hearing room. The protesters, mainly from a disability rights group and many of whom were in wheelchairs, were forcibly removed one-by-one from the hearing room as they yelled, “No cuts to Medicaid, save our liberty.” The hearing eventually proceeded for about five hours, but protests could be heard outside for more than an hour.

Television talk show host Jimmy Kimmel, who had become part of the debate on U.S. healthcare legislation in May after discussing his newborn son’s heart surgery, had taken aim at the bill in recent days. On Monday he tweeted: “Thank you @SenatorCollins for putting people ahead of party. We are all in your debt.”

A new CBS poll released on Monday said that a majority of Americans, or 52 percent, disapprove of the Graham-Cassidy bill, while 20 percent approve. The poll was taken between Sept. 21 and 24.

(Reporting by Susan Cornwell and Richard Cowan; Additional reporting by Timothy Gardner, Philip Stewart, Makini Brice, Amanda Becker and Alistair Bell in Washington and Caroline Humer in New York; writing by Timothy Gardner; Editing by Bill Trott and Mary Milliken)

Obamacare repeal must move quickly, says Senate’s McConnell

Activists participate in a rally to protect the Affordable Care Act outside the U.S. Capitol in Washington, U.S., September 19, 2017. REUTERS/Aaron P. Bernstein

By Susan Cornwell

WASHINGTON (Reuters) – The U.S. Senate’s top Republican on Tuesday urged quick action on a bill to repeal Obamacare but stopped short of promising to bring it to the Senate floor for a vote, as the clock ticks down on the latest attempt to kill the 2010 healthcare law.

Mitch McConnell, the Senate’s Republican leader, called the legislation drafted by senators Lindsey Graham and Bill Cassidy “an intriguing idea and one that has a great deal of support.”

Lawmakers should act because “our opportunity to do so may well pass us by if we don’t act soon,” McConnell said on the Senate floor.

The bill has revived a fight that many in Washington thought was over when an Obamacare repeal-and-replace bill flopped in the Senate in July, humiliating McConnell and President Donald Trump.

The latest measure has less than two weeks before procedural rules in the Senate make it much more difficult for the Republicans to do away with Obamacare.

The bill proposes replacing Obamacare with a system that would give states money in block grants to run their own healthcare programs and let them opt out of some Obamacare rules. Critics say it would bring deep cuts to the Medicaid program for the poor and higher insurance premiums for older people.

“Graham-Cassidy would be devastating for individuals with pre-existing conditions,” the Center for American Progress, a liberal think tank in Washington, said in a statement.

McConnell stopped short of promising to bring the legislation to the Senate floor. But he said Republican lawmakers would continue to discuss it. He has been meeting with lawmakers to assess whether the bill has the votes to pass.

The proposal is the latest salvo in a long-running Republican war on Obamacare, and Graham and Cassidy say they are close to securing the votes needed for passage.

If approved, it would replace the 2010 Affordable Care Act, known informally as Obamacare, which Republicans have long seen as government overreach into the healthcare business.

Several Republicans – the same ones whose votes blocked repeal of Obamacare in July – are still undecided on the latest bill and time is running out.

A special parliamentary procedure that would allow the bill to move forward with only 51 votes will expire at the end of the month. After that, it would need 60 votes, like most Senate legislation. Republicans have a 52-vote Senate majority.

The Senate Finance Committee said it will hold a hearing on the bill next week.

If the Senate can pass the bill, “the hope would be that the House would take it up and pass it and the president sign it,” said John Cornyn, the No. 2 Senate Republican.

Senate Democratic Leader Chuck Schumer said Republicans were “grossly irresponsible” to consider legislation before even getting a full assessment of its impacts from the non-partisan Congressional Budget Office.

(Additional reporting by Richard Cowan and Amanda Becker; Editing by Chizu Nomiyama and Alistair Bell)

Anthem cuts back Obamacare coverage in Missouri to 68 counties

FILE PHOTO: The office building of health insurer Anthem in seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas

NEW YORK (Reuters) – U.S. health insurer Anthem Inc said on Friday that it will no longer offer Obamacare plans in 17 counties in Missouri but will remain in the bulk of the state, covering 68 counties that would not otherwise have Obamacare coverage for their residents.

Health insurers are facing an upheaval in their businesses amid growing uncertainty about healthcare legislation under President Donald Trump, who seeks to follow through on his promise to dismantle former President Barack Obama’s signature healthcare law, formally known as the Affordable Care Act.

Insurers such as UnitedHealth Group Inc, Aetna Inc and Humana Inc have exited most of the states where they sold Obamacare plans, leaving hundreds of U.S. counties at risk of losing access to private health coverage in 2018.

But other insurers, including Centene Corp, have filled those gaps, expanding into counties that had lost their coverage options.

Every U.S. county is currently projected to have at least one insurer offering Obamacare individual coverage next year. Still, 1,476 counties could have only one insurer in 2018.

(Reporting by Michael Erman; Editing by Steve Orlofsky)

End of U.S. payments to health insurers would cause premiums to rise: CBO

FILE PHOTO: A patients room is pictured at a medical center hospital in San Diego, California, U.S., April 17, 2017. REUTERS/Mike Blake

By Yasmeen Abutaleb

WASHINGTON (Reuters) – Health insurance premiums for many customers on the Obamacare individual insurance markets would be 20 percent higher in 2018 if U.S. President Donald Trump follows through on a threat to stop billions of dollars of payments to health insurers, a nonpartisan congressional office said on Tuesday.

The Congressional Budget Office also found that terminating the payments would mean that 5 percent of Americans would live in areas that do not have an insurer in the individual market in 2018. However, the agency estimated that more insurers would participate by 2020 because they will have observed how the markets work without the payments and most people would be able to purchase insurance.

The CBO’s assessment echoes concerns raised by insurers over the past several months, who have said that terminating the payments would cause premiums to rise.

Trump has repeatedly threatened to withhold the payments, called cost-sharing reductions, which amount to about $7 billion in 2017 and help cover out-of-pocket medical expenses for low-income Americans. Trump has derided the payments as a “bailout” for insurance companies.

The CBO found that the number of uninsured would be slightly higher in 2018 but slightly lower in 2020 as more insurers joined the market. It also found that premiums would be 25 percent higher by 2020, which would increase the amount of government-provided tax credits to help shield low-income people from premium increases.

Several insurers have cited the uncertainty over the payments in raising insurance premiums by double digits for 2018 or in exiting some individual insurance markets.

Anthem Inc, one of the largest remaining Obamacare insurers, earlier this month scaled back its offerings in Nevada and Georgia and blamed the moves in part on uncertainty over the payments. Blue Cross and Blue Shield of North Carolina earlier this year raised premiums by more than 20 percent, but said it would have only raised premiums by about 9 percent if Trump agreed to fund the payments.

The payments are the subject of a lawsuit brought by House Republicans against the Obama administration that alleged they were unlawful because they needed to be appropriated by Congress. A judge for the federal district court for the District of Columbia ruled in favor of the Republicans, and the Obama administration appealed the ruling.

The Trump administration took over the lawsuit and has so far delayed deciding whether to continue the Obama administration’s appeal or terminate the subsidies. That case became more complicated earlier this month when a U.S. appeals court allowed Democratic state attorneys general to defend the payments and have a say in the legal fight.

The administration has decided month-to-month whether to continue the payments. Its next installment is due Aug. 21.

Trump has grown increasingly frustrated as Republicans, who control the White House, Senate and House, have been unable to pass a repeal or replacement of the Affordable Care Act, former Democratic President Barack Obama’s signature domestic policy achievement. After the Senate effort failed in July, Trump tweeted days later threatening to stop the payments.

The CBO estimated the federal deficit would increase by $194 billion from 2017 through 2026 if the payments are terminated.

(Reporting by Yasmeen Abutaleb; Editing by Michele Gershberg and Chris Reese)

Anthem to exit Obamacare market in Virginia next year

FILE PHOTO: The office building of health insurer Anthem is seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas/File Photo

(Reuters) – U.S. health insurer Anthem Inc <ANTM.N> said on Friday it will exit Obamacare markets in Virginia and reduce its plan offerings in Washington and Scott counties and the city of Bristol next year.

The move comes nearly two weeks after President Donald Trump took aim at insurers by threatening to cut the healthcare subsidy payments that make Obamacare plans affordable, after repeatedly failing in his efforts to dismantle former President Barack Obama’s healthcare law.

Insurers are facing an upheaval in their health insurance businesses due to uncertainty over the healthcare legislation as Republican lawmakers seek to follow through on their promise to repeal and replace the Affordable Care Act.

Health insurers, such as UnitedHealth Group Inc <UNH.N>, Aetna Inc <AET.N> and Humana Inc <HUM.N>, have also exited most of the states where they used to sell plans.

The insurers have asked the government to commit to making the $8 billion in subsidy payments for 2018, saying they may raise rates or leave the individual insurance marketplace if there is too much uncertainty.

On Monday, Anthem said it would no longer offer Obamacare plans in Nevada’s state exchange and half of Georgia’s counties in 2018.

The company said on Friday it will only offer off-exchange plans in Washington and Scott counties and the city of Bristol.

Hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as health insurers consider pulling out of those markets in the coming months.

Last week, Molina Healthcare Inc <MOH.N> said it would stop selling Obamacare plans in Utah and Wisconsin.

(Reporting by Divya Grover in Bengaluru; Editing by Shounak Dasgupta)

Anthem to pare back Obamacare offerings in Nevada and Georgia

FILE PHOTO: The office building of health insurer Anthem is seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas/File Photo

(Reuters) – U.S. health insurer Anthem Inc <ANTM.N> said on Monday it will no longer offer Obamacare plans in Nevada’s state exchange and will stop offering the plans in nearly half of Georgia’s counties next year.

The moves come after Republican senators last month failed to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

Hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as insurers consider pulling out of those markets in the coming months.

Nevada had said in June that residents in 14 counties out of 17 in the state would not have access to qualified health plans on the state exchanges. Anthem’s decision to leave the state entirely does not increase the number of “bare counties” in the state, Nevada Insurance Commissioner Barbara Richardson said in a statement.

The insurer will still offer “catastrophic plans,” which can be purchased outside the state’s exchange and are only available to consumers under 30 years old or with a low income.

Anthem also said it will only offer Obamacare plans in 85 of Georgia’s 159 counties. It said the counties it will continue to offer the plans in are mostly rural counties that would otherwise not have health insurance coverage for their residents.

It said these changes do not impact Anthem’s Medicare Advantage, Medicaid or employer-based plans in either state.

The company said last week that it will pull out of 16 of 19 pricing regions in California in 2018 where it offered Obamacare options this year.

Anthem blamed the moves in part on uncertainty over whether the Trump administration would maintain subsidies that keep costs down.

U.S. President Donald Trump last week threatened to cut off subsidy payments that make the plans affordable for lower-income Americans and help insurers to keep premiums down, after efforts to repeal the law signed by his predecessor, President Barack Obama, failed in Congress.

Trump has repeatedly urged Republican lawmakers to keep working to undo Obama’s Affordable Care Act.

(Reporting by Michael Erman and Bill Berkrot in New York; Editing by Chizu Nomiyama and Lisa Shumaker)

Hundreds of counties at risk for no Obamacare insurer in 2018

FILE PHOTO: Healthcare activists protest against the Republican healthcare bill on Capitol Hill in Washington, U.S., July 19, 2017. REUTERS/Aaron P. Bernstein

By Caroline Humer

NEW YORK (Reuters) – With Republican efforts to dismantle Obamacare in disarray, hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as insurers consider pulling out of those markets in the coming months.

Republican senators failed this week to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating new uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

In response, Republican President Donald Trump on Friday again suggested that his administration would let the Obamacare program “implode.” He has weakened enforcement of the law’s requirement for individuals to buy insurance, threatened to cut off funding and sought to change plan benefits through regulations.

Anthem Inc, Cigna Corp, Health Care Service Corp and Molina Healthcare, four of the biggest health insurers selling Obamacare plans, said they are weighing whether to pull out of more markets for 2018 rather than face financial losses. They have until Sept. 27 to finalize their plans.

So far, 40 U.S. counties are expected to have no insurer offering individual coverage next year, but that number could rise by the hundreds, according to U.S. government data, Kaiser Family Foundation analysis and insurer disclosures. More than 1,300 counties, primarily in 15 states, currently have only one insurer participating in 2018. Anthem and HCSC are the last man standing in one-third of those counties and states – putting those areas in particular at risk.

“Right now the number of counties at immediate risk of having no insurers in 2018 is small, but it could easily grow significantly if a couple major insurers decide to exit,” Larry Levitt, health economist at the Kaiser Family Foundation, said.

Many insurers have been waiting for an answer from Trump or lawmakers on whether they will continue to fund $8 billion in annual government subsidies. Without assurances, many insurers plan to raise rates an additional 20 percent by an Aug. 16 deadline for premium prices. Others say that the many unknowns will make the business too risky.

The last-minute drama has left millions of Americans questioning whether they will have medical coverage next year.

Julie Grady, a 59-year-old small business owner in Carson City, Nevada, is currently covered by Blue Cross Blue Shield of Nevada, part of Anthem, which has already decided to leave the exchanges in her county and most of the state. Carson City will have no insurer on the exchanges next year.

Grady’s pays a reduced premium of $70 per month and a deductible under $1,000 for her plan, which is part of the Affordable Care Act, commonly called Obamacare. Grady is looking at being uninsured, as she was before the law.

“I would have to go without health insurance,” she said. “I would just stay healthy, hike, eat well. I’d be in trouble if something catastrophic happened. I would lose everything.”

ANTHEM CONSIDERING 2018 PLANS

Anthem, the second-largest U.S. health insurer, sells Blue Cross Blue Shield plans in 14 states. It has already decided to pull out of most individual markets in Nevada, Ohio, Indiana and Wisconsin in 2018. Earlier this week, Chief Executive Officer Joe Swedish said he was still weighing 2018 participation in its other states.

In states like Colorado, Georgia, Kentucky, Missouri, and Virginia, Anthem sells plans in more than 250 counties where it is the only insurer, and they could be left “bare” next year, according to government data.

Health Care Services Corp is a Blue Cross Blue Shield licensee in five states and is the only Obamacare individual insurer in more than 90 Texas counties, more than 75 Oklahoma counties, and half a dozen Illinois counties. It confirmed on Friday that it has submitted products for its five states but is still weighing next year.

“We’re working through the regulatory filing process and hope to fully participate…in 2018, however no final decisions have been made,” HCSC spokeswoman Kristen Cunningham said.

Molina, which has more than 1 million members in Obamacare plans, and Cigna, with more than 250,000 participants, have said they need more certainty from the government to decide on 2018 participation and would weigh their decisions up until the late September deadline.

State insurance regulators have worked hard in recent months to replace insurers who have left. In Nevada, for instance, Centene Corp and Aetna Inc entered in some counties that Anthem left after the insurance commissioner said he would favor these insurers for its Medicaid contract bids.

But they are unlikely to find replacements for new dropouts in these final weeks, particularly if the Trump administration signals it won’t fund $8 billion in subsidies for out-of-pocket medical costs.

“There is almost no chance they would step in to participate,” said Kurt Wrobel, a fellow at the Society of Actuaries and chief financial officer of the Geisinger Health Plan in Pennsylvania.

Some insurers say they will likely just raise rates and hope it works. Blue Cross Blue Shield of Michigan filed two sets of rates with the state department of insurance, one up to 32 percent higher if the fate of subsidies remains unclear.

“We don’t have any plans to pull out,” said Rick Notter, director of the individual business at BCBS Michigan. “But it would certainly help to have more certainty around what the market holds.”

(Additional reporting by Jilian Mincer; Editing by Michele Gershberg and Cynthia Osterman)