In addition, Swedish warned that Anthem may be forced to pull out of markets or raise rates as much as 20 percent if lawmakers decided to pull the funding that reduces the cost of coverage for low-income customers, known as cost-sharing subsidies.

Health insurers, including Anthem, are pressing President Donald Trump and Congress to guarantee the subsidies. Anthem says it needs an assurance of them by early June.

The subsidies are paid directly to insurers, and they help trim out-of-pocket costs like deductibles for customers with low incomes. Nearly 3 in 5 consumers on the exchanges qualify for this help, which totaled about $7 billion this year and is separate from the income-based tax credits people get for their insurance bill.

In Missouri, Anthem has sold health insurance plans through the online exchange since its launch in 2014. Other health insurers have already left the exchanges.

Aetna, which does business as Coventry here, and UnitedHealthcare decided to quit selling exchange plans in 2017. Their departures left 96 of Missouri’s 114 counties without an insurance carrier. Exchange plans are separate from coverage obtained through employers. Anthem has no plans to stop providing insurance to employer groups.