Is Anthem the next insurer to exit the federal marketplace?

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WASHINGTON – Indianapolis-based Anthem has issued another warning to Congress, as the budget deal reached late Sunday night excludes key funding for insurance companies, those familiar with the plan’s details tell FOX 59.

The House could vote on repealing and replacing the Affordable Care Act as early as this week, if Republican leaders shore up enough votes. And over the weekend, President Trump promised the bill will include mandated coverage for those with pre-existing conditions.

“Pre-existing conditions are in the bill,” Trump told CBS News in an interview Sunday on Face the Nation. “And I mandate it. I said, ‘has to be.’”

The latest House version, though, doesn’t guarantee coverage for pre-existing conditions. It instead would allow states to opt-out of the mandate.

“There are so many people that are so nervous that their pre-existing condition won’t be covered,” Susan Rider said, a consultant with Gregory & Appel in Indianapolis. “So ultimately whether that is through a high-risk pool or through ACA as it is today or another option, we really don’t know yet.”

Meantime in a conference call with investors last week, Anthem CEO Joseph Swedish said the insurer would consider pulling out of the federal marketplace if Congress doesn’t continuing paying subsidies to insures, as part of the Affordable Care Act, to help cover low-income Americans.

Those briefed on specifics of the budget deal said Monday the agreement does not include the cost-sharing reduction subsidies for companies like Anthem.

“We are notifying our states that if we do not have certainty that CSRs will be funded for 2018 by early June, we will need to evaluate appropriate adjustments to our filing,” Swedish said. “Such adjustments could include reducing service area participation, requesting additional rate increases, eliminating certain product offering or exiting certain individual ACA-compliant market altogether.”

Anthem would joining a list of major insures who have already left the marketplace, including UnitedHealthCare, Humana and Aetna.

Swedish said the company expects to provide “additional clarity” by June.