Anthem plans to exit Nevada's exchange, reduce its presence in Georgia next year

Anthem will entirely exit Nevada's Affordable Care Act exchange next year, though the move won't leave any additional "bare" counties in the state.

Continuing its methodical retreat from the Affordable Care Act exchanges, Anthem announced that it will exit Nevada’s exchange entirely next year and extract itself from 74 of Georgia’s 159 counties.

The major insurer, which currently offers Blue Cross Blue Shield plans on 14 states’ exchanges, cited the continued volatility of the individual marketplaces as the reason for its decision. Driving this volatility, Anthem said in a statement, is uncertainty over funding for cost-sharing reduction (CSR) payments and the restoration of taxes on fully insured coverage.

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Anthem had previously indicated it would exit all but three Nevada counties in 2018, leaving 14 of the state’s 17 total counties without any on-exchange option next year. Now the company will offer just one statewide off-exchange catastrophic medical plan, which is only available to consumers younger than 30 or with low incomes, according to Insurance Commissioner Barbara Richardson.

“The division is continuing to work with our state partners on attracting an insurance carrier to serve the 14 bare counties and to support the stability of the market for those insurance carriers who remain,” she said.

In Georgia, Anthem said it will continue selling on- and off-exchange plans in 85 counties that are primarily rural and would “otherwise not have health insurance coverage for their residents.”

In addition to Monday’s announcement, Anthem has already said it will pull out of the exchanges in Wisconsin, Indiana and Ohio. It also plans to significantly reduce its on-exchange presence in California. In all of the states Anthem has said it plans to exit, though, it will continue offering at least one off-exchange plan—allowing it to avoid a five-year ban from re-entering the exchanges that it would have faced if it completely stopped offering individual market plans in any given state.

Anthem’s latest announcement won’t leave any additional bare counties nationwide, according to the Kaiser Family Foundation. The most recent estimate of bare counties is 17—a figured that dropped by nearly half when five insurers stepped in to fill coverage gaps on Ohio’s exchange.

More bare spots could emerge, however, ahead of the Sept. 27 deadline for insurers to finalize their plans for participation on the ACA exchanges in 2018. Indeed, Anthem CEO Joseph Swedish said during the insurer’s second-quarter earnings call that it will further narrow its level of exchange participation if it doesn’t quickly gain certainty about issues like the funding of CSR payments.