Anthem, Health Tradition pulling out of state’s federal exchange

Two insurance companies serving Wisconsin are set to leave Healthcare.gov next year, but the state’s other participating insurers have filed preliminary paperwork to continue offering plans.

Anthem Blue Cross and Blue Shield in Wisconsin and Health Tradition Health Plan cited financial risks and uncertainty about the Affordable Care Act’s future as why they’re leaving.

Next year, Anthem, which currently serves 34 counties in the state, will offer one individual plan in Menominee County. The plan won’t be offered through Healthcare.gov. The decision affects about 14,000 members.

Health Tradition Health Plan, which currently serves 14 counties in western Wisconsin, plans to leave the individual market as well as the Small Business Health Plans option offered under the federal health reform law.

That will affect 9,000 members in the individual market, and less than 2,000 enrolled in small business plans, according to a spokesman.

Both companies will continue offering coverage until the end of this year.

State’s other Healthcare.gov, individual market participants set to stay

Other companies serving the state’s individual market confirmed to Wisconsin Health News that they’ve submitted preliminary paperwork to continue doing so. And Medica, which filed to continue to participate in its 13-county service area, plans to expand, although a spokesman declined to provide details.

Molina Healthcare has submitted an initial filing to participate in Wisconsin and the other eight states in which it operates. A spokeswoman wasn’t able to comment beyond that as “these are just preliminary filings.”

Dean Health Plan also plans to offer health plans on Healthcare.gov next year.

“Our current expectation is to continue serving our local communities with health insurance options to access our network of providers,” spokesman Ben Klepzig wrote in an email. “We are closely monitoring legislative activity in Washington and hope any changes to the Affordable Care Act continue to support Wisconsin’s healthcare environment.”

Security Health Plan has also filed to serve the individual market, both on and off the exchange. Marty Anderson, chief marketing officer, said the service area will look “99 percent the same,” with a “couple of county shifts” but no big impact from a “membership perspective for us.”

Anderson said they are staying because it fulfills their mission as a health system to provide access to high quality, affordable healthcare.

Since they’re a regional plan, they’d still likely see the same patients in their Medicaid, Medicare or group insurance populations if they left the market.

“It just means if they don’t have insurance now, they’re going to have significant health conditions when they do enter one of those other coverage types,” he said. “So it’s a pay now or pay later type of situation.”

Security also has concerns over the future of cost-sharing reductions, which help low-income consumers afford coverage. If the federal government doesn’t make the payments, it would make the company “take a hard look at their participation in 2018,” Anderson said.

Aspirus Arise filed paperwork to serve the individual market. A spokesman declined to say whether the plans would be through Healthcare.gov, but said they’re not planning to change their service area.

Network Health Plan has also filed to serve the same service area. Gundersen Health Plan and Unity Health Insurance, which are now integrated under the brandname Quartz, have also filed to serve the market.

Common Ground Healthcare Cooperative, the state’s nonprofit cooperative founded under the Affordable Care Act, will continue serving the exchange. Children’s Community Health Plan plans to stay as well, Bob Duncan, executive vice president at Children’s Hospital of Wisconsin, said at a Milwaukee Press Club event Wednesday.

Group Health Cooperative of South Central Wisconsin has filed paperwork to remain with the exchange. They don’t anticipate changes to their 13-county service area.

“GHC has always been supportive of the ACA and believe it’s still good public policy,” said Al Wearing, the company’s chief insurance services officer. “The economics of it are becoming very challenging, but we’re going to continue.”

HealthPartners has also filed to participate on Healthcare.gov, but declined to provide additional information. MercyCare Health Plans has also filed to provide coverage on the exchange.

Physicians Plus, which left Healthcare.gov last year, plans to continue offering individual plans off the exchange.

“With the uncertainty around the exchange’s direction and financing, along with administrative costs to participate we have decided to monitor the exchange activity in 2018,” spokeswoman Rachel Hill-Smith said in a statement. “At this time there are no plans to change service areas for these plans in 2018.”

WPS Health Solutions, which left Healthcare.gov last year, also won’t sell on the exchange next year. But Arise and WPS still plan to offer coverage off the exchange.

Anthem’s announcement turns political

Anthem’s departure drew commentary from the state’s lawmakers. Republicans blamed the Affordable Care Act and its regulations, while Democrats said the GOP has sought to undermine the law.

Gov. Scott Walker said the withdrawal shows that “Obamacare is collapsing.” House Speaker Paul Ryan, R-Janesville, issued a similar statement. “We have to step in before more families get hurt,” he said.

Sen. Jon Erpenbach, D-Middleton, blamed state and national Republicans, saying they have “done nothing but try to sabotage the Affordable Care Act.”

“You can trace Anthem’s decision to the instability President Trump and Republicans in Congress have injected into the healthcare marketplace,” U.S. Rep. Mark Pocan, D-Madison, said in a statement.

Anthem spokesman Jeff Blunt said they were pleased by “some steps” that were taken to address long-term challenges health plans are facing in the market, like “improving eligibility requirements” that allow consumers to buy coverage outside open enrollment.

“However, the Wisconsin individual market remains volatile, making planning and pricing for ACA-compliant health plans increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage,” he wrote in an email.

The company has about 18,500 members in the individual market, with about a quarter of enrollees in plans that went into effect before the Affordable Care Act was implemented. Those so-called “grandmothered” and “grandfathered” plans aren’t affect by Wednesday’s decision, Blunt said.

Blunt said he couldn’t discuss the insurer’s decision to only offer an individual plan off-exchange in Menominee County due to “competitive reasons.” But he said offering a plan in one county allows the company to maintain state eligibility requirements to “re-enter the individual market should it stabilize in the coming year.”

“We hope to do so,” he wrote in an email.

Currently, Molina Healthcare is the only company that offers coverage in Menominee.

Todd Catlin, an insurance agent who co-owns Brookfield-based Transition Health Benefits, threw cold water on the ramifications of Anthem’s exit. He said that Anthem has scaled back its ACA business significantly since the law took effect.

“It think it’s going to have very little impact,” he said at a Milwaukee Press Club event Wednesday.