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More than 206,000 Virginians could lose their individual health insurance policies with the sudden withdrawal of Anthem Blue Cross Blue Shield in Virginia, the state’s largest insurer, from the federal exchange and individual market in 2018.

The Richmond-based company announced the choice late Friday, citing “the shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies and the restoration of taxes on fully insured coverage.”

Anthem’s choice follows Aetna’s announcement in May that it would exit the federally operated marketplace in Virginia for the Affordable Care Act in 2018.

Virginia Insurance Commissioner Jacqueline K. Cunningham called Anthem’s withdrawal “unwelcome news for many Virginia consumers” and emphasized that the company would continue to offer insurance plans through employers, Medicare and Medicaid.

“Despite efforts by the Bureau (of Insurance) to encourage Anthem HealthKeepers to remain in the individual market in all of its Virginia service areas in 2018, the company ultimately made the choice to exit virtually the entire market,” said Cunningham, who runs the bureau at the State Corporation Commission.

According to the SCC, Anthem Health Plans and HealthKeepers Inc. — Anthem’s managed care plot — held a combined 34.03 percent of the market share of Virginia’s accident and sickness insurance as of the end of 2016.

Jill A. Hanken, health attorney at the Virginia Poverty Law Center, called the choice “very disappointing” but said Congress has time to stabilize the market by continuing subsidies to reduce cost-sharing payments by the poorest customers and fund reinsurance pools to cover people with expensive pre-existing conditions.

“There are still five insurers in Virginia’s marketplace – Optima, Kaiser, Piedmont, Cigna and CareFirst,” said Hanken, whose organization runs a federally funded health navigator system to help people find affordable insurance. “As of now, every locality in Virginia still has at least one company offering health plans through the marketplace,” which currently serves 360,000 Virginians.

Doug Gray, executive director of the Virginia Association of Health Plans, called the flight of insurers an opportunity for a bipartisan group in the U.S. Senate that expects to meet next month to consider ways to bolster health insurance markets.

“I hope these senators consider the most basic things needed to be done to ensure stability over a minimum of two years,” Gray said.

Anthem’s announcement set off an immediate political firestorm, with conservative Republican leaders proclaiming the inevitable collapse of “Obamacare,” while Democrats and other supporters of the health care law place the blame on President Donald Trump and the Republican-controlled Congress for undermining insurance markets by attempting to repeal the law instead of fixing it.

Gov. Terry McAuliffe, a Democrat, said Anthem leaders told him Friday they were reacting to “the president’s threats to cut off cost-sharing reduction payments to insurers and his deliberate attempts to dismantle the individual insurance market.”

“It’s unfortunate Anthem felt it could no longer participate in the exchange because of the uncertainty made by the president and Congress,” McAuliffe said in statement

Anthem said it would not comment beyond its written statement.

The governor called for the Trump administration to “stop playing games with people’s lives and come together in a bipartisan way to provide certainty for insurers” so that the federal government would continue to fund cost-sharing reductions through 2018.

But, Speaker of the House William J. Howell, R-Stafford, and Senate Majority Leader Thomas K. Norment Jr., R-James City, pounced on Anthem’s choice as proof that the Affordable Care Act, or Obamacare, should be repealed and replaced.

“Obamacare is hurting more people than it is helping, forcing Americans to buy insurance that they don’t like, don’t need, and can’t afford,” Howell said in a statement on Friday.

Not all state Republican leaders agreed.

Senate Finance Co-Chairman Emmett W. Hanger Jr., R-Augusta, said Anthem’s choice was “not really unexpected” given the turmoil in Washington over the collapse of Republican proposals to repeal the Affordable Care Act and subsequent statements by Trump that he might not continue to fund the cost-sharing subsidies and other measures for shoring up the market.

“The uncertainty is going to kill the market, and the market was beginning to work honestly decently in Virginia,” said Hanger, who has bucked Republican leadership in the General Assembly by supporting an unsuccessful attempt to expand private health insurance coverage through Medicaid in 2014.

Anthem’s choice could trigger a quick meeting of a bipartisan subcommittee of both legislative chambers that formed this year to monitor potential federal actions on health care that could affect Virginia, including the individual insurance market and the state’s Medicaid program.

“I reckon we will have to meet,” said Hanger, who is vice-chairman of the joint subcommittee.

Norment, who is also co-chairman of the Senate Finance Committee, place a sharp partisan edge on the failure of Congress to repeal and replace the Affordable Care Act. “The federalization of health care, authored and enacted solely by Democrats, has been an abject failure,” he said in a statement.

“The 48 Democrat and three Republican senators who refused to vote for change two weeks ago today have a responsibility to end their recalcitrance and act now to fix this,” the  majority leader said in a pointed rebuke of Republican senators Susan Collins of Maine, John McCain of Arizona, and Lisa Murkowski of Alaska, who voted against the proposed repeal of the law.

Virginia’s two U.S. senators, Mark R. Warner and Timothy M. Kaine, both Democrats and former governors, blamed the market departure of Anthem and other insurers on “the uncertainty, mixed signals and deliberate sabotage from the Trump administration.”

“President Trump has been playing politics with health care for months now, and unfortunately, Virginians will be the ones paying the price,” Warner and Kaine said in a joint statement on Friday.

After U.S. Senate Republicans fell small last month in their attempt to repeal and replace the Affordable Care Act, Trump said he would “let Obamacare fail.”

Virginia Secretary of Health and Human Resources Bill Hazel, a retired orthopedic surgeon who has served both Republican and Democratic governors, said Friday that Congress has long known what is necessary to stabilize insurance markets “but the politics got a hold of it.”

“We wasted the whole summer on ‘repeal and replace’ while we did nothing for the markets,” Hazel said.

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