The nightmare scenario for Obamacare keeps getting worse

Anthem announced Tuesday that it will not participate in Affordable Care Act individual health insurance exchanges in Ohio for the 2018 plan year, potentially leaving 20 counties in the state without any Obamacare marketplace plans.

In a statement to Business Insider, Anthem cited uncertainty in the market due to possible policy changes from the Trump administration and lawmakers on Capitol Hill.

From the statement:

"We are pleased that some steps have been taken to address the long term challenges all health plans serving the individual market are facing, such as improving the eligibility requirements that allow consumers to purchase a plan outside of open enrollment and improved risk adjustment. However, 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."

Cynthia Cox, an associate director the Kaiser Family Foundation, a nonpartisan health policy think tank, said the move would leave exchanges in 20 Ohio counties with no insurer. That would affect 13,000 people, or 6% of the marketplace enrollees in Ohio, Cox tweeted.

Counties with no insurers have long been considered a worst-case scenario for Obamacare, the health law championed by President Barack Obama, as there is no back-up provider if another insurer does not step in to fill the void.

Anthem's move follows a cascade of insurer exits in states such as Nebraska, Virginia, Iowa, and more. In other states, insurers are requested dramatic increases in the cost of premiums due to the political uncertainty surrounding the law.

Insurers, including Anthem, have singled out Obamacare's so-called cost-sharing reduction (CSR) payments as a source of instability. The payments help to offset the cost for insurers of providing cheaper coverage to low-income Americans. Currently, the executive branch appropriates the money for the critical payments. Insurers fear that the Trump administration may cut off the funds, though they were recently extended for 90 days.

In its statement, Anthem said that if there were changes to the individual market, the company would consider returning to the exchanges.

"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," said the statement.