A big Obamacare shoe just dropped in Ohio. Health insurer Anthem said Tuesday it will effectively exit its Obamacare individual plan business in Ohio, leaving potentially 18 counties in the Buckeye State with no insurer selling plans in 2018. Anthem, which sells Obamacare plans in 14 states this year, left open the door to dropping out of other states next year. The company this year sold individual health plans in all 88 counties in Ohio, the only Obamacare insurer to cover the whole state. But next year, Anthem said, it will sell just a single plan in Pike County, and that will only be available outside of the Obamacare federal marketplace, HealthCare.gov. There are 10,500 current Anthem customers in the 18 counties who are currently not expected to have an Obamacare plan available as a result of Anthem's planned exit, which was revealed a day after the deadline for filing proposed rates in Ohio for next year. The company, in explaining what it called "a difficult decision," pointed to continued "volatility" in the individual health plan market, as well as to uncertainty about whether President Donald Trump and the Republican-controlled Congress will continue paying insurers reimbursements for key Obamacare subsidies that reduce low-income customers' out-of-pocket health costs. The company also blamed the restoration of a tax on insurers. "An increasing lack of overall predictability simply does not provide a sustainable path forward to provide affordable plan choices for consumers," said Anthem. "As the Individual marketplace continues to evolve, Anthem will continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future," the company said.

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"We participated in [Obamacare] exchanges in all of our 14 states this year," an Anthem spokeswoman said. "Regulations and deadlines for making the decisions regarding our participation vary by state and we intend to continue our dialog with regulators in our markets until that time." The Ohio Department of Insurance said there were 17 companies selling Obamacare plans in the state through the federal marketplace HealthCare.gov in 2016. That dropped to just 11 companies this year. Anthem currently is the only Obamacare insurer in the state's 20 counties that have just one insurer. The insurance department said that based on preliminary rate filings for 2018 Anthem's pullback across the state will leave at least 18 counties with no Obamacare insurer next year. "For the past few years, we have seen a weakening in the federal insurance marketplace as a number of companies have withdrawn from the exchange," said Chris Brock, a spokesman for the state's insurance department. "We have always argued the private insurance market is the most severely impacted by the federal law and that is where congressional action is needed to restore stability." "The Department of Insurance is looking for options to help the approximately 10,500 Ohioans in counties where there may not be an exchange plan when this takes effect in 2018," Brock said. Anthem will continue selling small-group and large-group health plans in Ohio, which currently cover about 3.4 million people.

Gus Ruelas | Reuters