Another big healthcare insurer is taking a wait and see attitude about scaling back or getting out of the public health exchange market.
Anthem Inc. may pull out of the exchange market altogether in advance of a major legislative overall of all or major portions of Obamacare, CEO Joseph Swedish told Wall Street analysts yesterday on the company’s year-end earnings call. An Anthem withdrawal from Healthcare.gov would mean the loss of one of the exchange market’s biggest participants and further curb consumer choice in many states.
Anthem now writes coverage for about 893,000 consumers on the public exchange market or about 7%, of the 12.7 million consumers that bought health insurance online via a public exchange. Anthem participates on the health exchanges in 14 states, including California.
“While the direction in Washington has been positive, we still need certainty about short-term fixes in order to determine the extent of our participation in the individual market in 2018,” Swedish told analysts according to a transcript for SeekingAlpha.com. “We will be watching developments closely in the first half of 2017 as we evaluate our longer-term strategy for the health insurance exchanges.”
Anthem doesn’t break out its public exchange revenue. That number is lumped in with Anthem’s commercial and specialty line operating revenue, which grew year over year 3.0% to $38.69 billion from $37.57 billion. Total operating revenue for the year ended Dec. 31 increased 7.9% to $84.19 billion from $78.04 billion in 2015. Net income was $2.47 billion compared with $2.56 billion in 2015.
Anthem wants to see several changes before deciding whether to continue participating in the public exchange market. The biggest change is adjusting the risk pool so the sickest and most expensive healthcare policies to pay and administer are spread out more evenly, Anthem says. “Changes are needed to ensure both a stable and sustainable individual market and a smooth transition for consumers. Specifically, steps must be taken to address two key shortcomings in the current market—risk pool integrity and affordability,” Swedish told analysts.
The fact that enrollment on Healthcare.gov has reached less than half the goal that the federal government had set for 2018—26 million consumers—is a major sign public exchanges need to be overhauled, chief financial officer John Gallina told analysts. “Commercial insured mix was a headwind,” Gallina noted. “The most significant of which was the ACA exchanges, the fact that there was supposed to be 26 million people enrolled in the exchanges by 2018, and we’re at far, far short of half of that from a basis within the country, and what the impact is on us.”
In previous meetings with Wall Street investors Anthem noted that the company expected a “mid-single-digit loss” on its 2016 exchange book of business—a result Anthem expects to improve on this year. “At this time we do not yet have visibility on the makeup of our renewal membership or the health of the overall risk pool,” Swedish told analysts. “Our outlook continues to expect our individual ACA-compliant plans to be breakeven to slightly profitable in 2017.
Anthem, which in August 2015 announced a deal to acquire Cigna Inc. for $54 billion, also expects a ruling soon from a federal court judge on whether the proposed venture violates antitrust law. “We’re very confident that we should be getting a decision very soon,” Swedish told analysts. “You may recall, she did say somewhere in the end of the month time frame, and I think it’s come upon us, so we’ll see when it happens.”