Anthem is exiting the ObamaCare marketplace in Ohio, leaving around 20 counties in the state without an insurer willing to sell a health plan in its exchange for 2018.

The company cited uncertainty as a reason why it’s exiting the exchanges in all of the state’s counties, particularly the question of whether or not the Trump administration will continue payments to insurers that compensate them for reducing out-of-pocket costs for lower-income enrollees.

“The Individual market remains volatile and the lack of certainty of funding for cost sharing reduction subsidies, the restoration of taxes on fully insured coverage and, an increasing lack of overall predictability simply does not provide a sustainable path forward to provide affordable plan choices for consumers,” Anthem said in a statement.

Sen. Rob Portman Robert (Rob) Jones PortmanMcConnell locks down key GOP votes in Supreme Court fight Romney undecided on authorizing subpoenas for GOP Obama-era probes Congress needs to prioritize government digital service delivery MORE (R-Ohio) issued a statement shortly after the announcement, saying “this is one more reason why the status quo on health care is unsustainable. The Affordable Care Act has failed to meet the promises that were made to Ohio families.”



Rep. Patrick Tiberi (R-Ohio), who represents a county now at risk of having no ObamaCare insurers, said the healthcare law is "collapsing under its own weight."



“The House started the process in the American Health Care Act to repeal Obamacare and replace it with needed solutions to restore the free market, lower costs and increase choices," Tiberi said. "It is now the Senate’s turn to deliver on our promise to move health care reform forward so that Ohioans and all Americans have reliable access to the care they need.”



Anthem's exit is seemingly due to political and regulatory uncertainty, none of which is specific to Ohio, Cynthia Cox, associate director for the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, wrote in an email.



"This could be the first of more exits," she wrote. "If the company exits nationally, there could be more than 275,000 people with no insurer option."



Anthem’s move comes as Senate Republican leaders are presenting options for an ObamaCare repeal-and-replace bill during the chamber’s GOP lunch Tuesday.



Ohio isn’t the only state with an ObamaCare insurance void. Missouri currently has about 25 so-called bare counties, meaning it could have zero options on its exchange.



That happened to Tennessee earlier this year, but BlueCross BlueShield of Tennessee stepped in to sell plans for 2018 with the caveat that it could exit the market “in the event of any post-bid changes that destabilize the market,” it said in a letter.



This year of uncertainty has prompted insurance commissioners to offer new flexibilities to try and keep insurers in the market.

Insurers want to make sure that the cost-sharing reduction payments will continue, which total about $7 billion. There’s also the question of if Republicans will be able to pass legislation repealing and replacing ObamaCare.



This story was updated at 2:08 p.m.