Blue Cross Blue Shield of Kansas City announced Wednesday that it would pull out of the individual exchanges established by the Affordable Care Act in Missouri and Kansas, dealing a huge blow to that market and sending a worrying signal about the future of the healthcare law, better known as Obamacare.

The insurer, also known as Blue KC, cited two reasons for its exit: losses sustained since it entered the exchanges in 2014, and the uncertain future of healthcare policy.

"Like many other health insurers across the country, we have been faced with challenges in this market," Danette Wilson, CEO of Blue KC, said in a statement. "Through 2016, we have lost more than $100 million. This is unsustainable for our company. We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of this market is a barrier to our continued participation."

Cynthia Cox, an associate director at the Kaiser Family Foundation, a nonpartisan health-policy think tank, said the move could leave many areas of Missouri with no option on the exchanges.

"BCBS of KC is the only exchange insurer in much of western Missouri,"Cox tweeted. "Their exit could leave almost 25 counties without coverage."

Exchanges that have no insurers have few other options. The state could suspend the penalty for not having insurance and allow people to go uninsured. Another option, used in places like Arizona and Tennessee, is to persuade another insurer to step in and cover the gaps.

In both Arizona and Tennessee, however, a Blue Cross Blue Shield company intervened to bolster the market, which does not appear to be possible in this case. Cox told Business Insider in an interview on Tuesday that the BCBS plans were critical for the survival of the exchanges.

"If the Blue Cross Blue Shield plans or Anthem pull out of the exchanges, then that would be a serious problem for many parts of the country, because that would mean that there would be counties without an insurance company," Cox said. "Whenever there is one insurance company right now, it almost always is either a Blue Cross Blue Shield or Anthem plan. It goes to show how much the exchanges rely on those plans."

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The Congressional Budget Office on Wednesday released an updated score for the American Health Care Act, the House GOP healthcare bill, that said it could leave millions more uninsured and undermine protections for people with preexisting conditions.

The CBO projected that 23 million more Americans would be uninsured by 2026 compared with the current healthcare system — slightly lower than the 24 million more Americans it estimated would be uninsured under the previous iteration of the bill.

"Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums," the CBO's report said.

The report, conducted in the wake of two amendments to the bill before it passed the House earlier this month, projected that the AHCA would cut the federal deficit by $119 billion — $32 billion less than the savings the CBO estimated in March.

That aspect is crucial because Republicans introduced the bill using a process known as budget reconciliation, which means it must be projected to shave at least $2 billion from the federal deficit to be able to pass with a simple majority in the Senate. House Speaker Paul Ryan had delayed sending the bill to the Senate in anticipation of the latest CBO score.

The report also confirmed one of the biggest worries of health-policy experts and constituents: that the bill could undermine protections for people with preexisting conditions.

The CBO looked at the possible effects of an amendment that would allow states to apply for a waiver to repeal the essential health benefits and community-rating protections established by the Affordable Care Act, the healthcare law also known as Obamacare.

Ryan, who championed the AHCA, said the report confirmed it "achieves our mission: lowering premiums and lowering the deficit." But Democrats and some Republicans slammed the bill and suggested that a new approach might be needed.

"With today's news, the 'collapse and replace' of Obamacare may prove to be the most effective path forward," Republican Sen. Lindsey Graham of South Carolina said on Wednesday.

About one-sixth of the US population lives in a state that the CBO projects would receive a waiver for community rating, which mandates insurers charge people of the same age living in the same area the same premiums. Health-policy experts have said that by repealing community rating, insurers could charge people with preexisting conditions more and price them out of the market.

That concern was echoed by the CBO and Joint Committee on Taxation's report, which projected that sick people could eventually be priced out of insurance:

"CBO and JCT expect that, as a consequence, the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under HR 1628 to help reduce premiums."

The report's conclusions run contrary to statements from Republicans leaders who had said that even with the waiver provision, the AHCA had "layers of protections" to make sure people with preexisting conditions would be covered.

The CBO said that about one-third of the population lived in states that would receive waivers for the essential health benefits, a set of procedures and care — such as maternity care and emergency-room visits — that insurers are mandated to cover. Their elimination would cause premiums to fall 20% from the current baseline in those states, according to the CBO, because "insurance policies would provide fewer benefits."

In states that waive the benefits, the CBO said, more people could have coverage but end up paying higher costs.

"Although premiums would decline, on average, in states that chose to narrow the scope of EHBs, some people enrolled in nongroup insurance would experience substantial increases in what they would spend on healthcare," the report said. "People living in states modifying the EHBs who used services or benefits no longer included in the EHBs would experience substantial increases in out-of-pocket spending on healthcare or would choose to forgo the services."

The report said out-of-pocket costs for things like maternity care, substance-abuse treatments, and mental-health care would increase substantially for some people.

In its earlier reports, the CBO said previous versions of the AHCA would not cause the ACA's individual insurance exchanges to become unstable. With the waiver provision, however, that wouldn't be the case.

"The agencies estimate that about one-sixth of the population resides in areas in which the nongroup market would start to become unstable beginning in 2020," the report said. "That instability would result from market responses to decisions by some states to waive two provisions of federal law, as would be permitted under HR 1628."

The Senate is expected to craft a healthcare bill of its own instead of using the current form of the AHCA.

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The Congressional Budget Office on Wednesday released its latest projections for the GOP healthcare bill, and one new detail showed the newest version of the bill could lead to a disaster that Republicans feared under Obamacare.

In every previous CBO score for both Obamacare and the American Health Care Act, the CBO had said the individual insurance market would remain stable.

That means the marketplaces where people who do not receive coverage through their job or a government program like Medicaid would continue to be able to purchase insurance at an affordable price.

But the final version of the GOP's American Health Care Act, the CBO said, would undermine that stability.

One of the additions to the AHCA since the CBO's last judgment on the legislation came with the MacArthur amendment, which would allow states to waive two of Obamacare's biggest protections: so-called community rating and essential health benefits.

Essential health benefits mandate that insurers cover a baseline of healthcare needs, like maternity care and mental-health services. Community rating compels insurers to charge the same amount to people of the same age in the same area.

The CBO said states that get waivers for those provisions could see a number of adverse effects. For instance, without community rating, people with preexisting conditions could be charged more for insurance, even to the point where it becomes unaffordable to purchase insurance.

These changes and their effects on premiums in the individual market, according to the CBO, could cause insurers to pull out of the market and prices to increase. 

From the CBO report:

"Decisions about offering and purchasing health insurance depend on the stability of the health insurance market — that is, on the proportion of people living in areas with participating insurers and on the likelihood of premiums’ not rising in an unsustainable spiral. The market for insurance purchased individually with premiums not based on one’s health status — that is, non-group coverage without medical underwriting — would be unstable if, for example, the people who wanted to buy coverage at any offered price would have average health care expenditures so high that offering the insurance would be unprofitable."

Put another way, people could exit the market for a variety of reasons — for example, if they're sick and the new plans cost too much, or if the plans cover so little without essential health benefits that out of picket costs are high enough to not make the insurance worth it. That could lead to a risk pool of only the sickest people. This could then lead to market instability.

The CBO did say this would only to parts of the country that theoretically request waivers. But it also projected "one-sixth of the population resides in areas" where the exchanges would "become unstable beginning in 2020."

One-sixth of the population is roughly 54 million Americans.

SEE ALSO: CBO says GOP healthcare bill would leave 23 million more uninsured, undermine protections for people with preexisting conditions

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Rep. Mark Meadows, the leader of the conservative House Freedom Caucus, reportedly got emotional talking about family members' struggles with preexisting conditions after reading the Congressional Budget Office's analysis of the Republican healthcare bill.

According to Haley Byrd at the Independent Journal Review and Robert King at the Washington Examiner, reporters showed Meadows a section of the Congressional Budget Office's report on the American Health Care Act, which passed the House with only Republican votes on May 2, that pertained to preexisting conditions.

The report said people with preexisting conditions in states that could accept a waiver under an AHCA provision could see their premiums skyrocket and even be priced out of the insurance market.

Byrd reported that Meadows was "surprised" when he was shown the section and he became "emotional" and "choked back tears" talking about his father's and sister's battles with cancer.

"Listen, I lost my sister to breast cancer," Meadows said, according to Byrd. "I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it's me. I'm not going to make a political decision today that affects somebody's sister or father because I wouldn't do it to myself."

The Examiner similarly reported that Meadows became "emotional."

Meadows told reporters he would support changes to the bill in the Senate to properly fund high-risk pools to protect people with preexisting conditions. He said that if the bill did not have "enough funds there to handle preexisting conditions and drive down premiums," then "we will have failed."

The CBO cited an amendment from Rep. Tom MacArthur that would allow states to get the waivers as the primary way the bill would undermine protections for people with preexisting conditions.

The amendment — added after the AHCA was pulled from the House floor before a vote in March, in part because of a lack of support from Meadow's Freedom Caucus — helped win over about 20 members of the Freedom Caucus to support the bill's eventual passage.

SEE ALSO: CBO says GOP healthcare bill would leave 23 million more uninsured, undermine protections for people with preexisting conditions

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The Congressional Budget Office on Wednesday released an updated analysis of the American Health Care Act, the House GOP healthcare bill, that economists and advocates said contained some alarming takeaways for the future of the fight against the opioid crisis.

While the nonpartisan CBO projected that 23 million more Americans would be uninsured by 2026 under the AHCA compared with projections under the current healthcare system, two other issues are contained within those numbers.

The first: The newly amended AHCA keeps largely in place the more than $800 billion in cuts to federal Medicaid spending over the next decade from the original version of the bill.

It does so by rolling back the Medicaid expansion established under the Affordable Care Act as well as other changes under the law. The CBO estimates that, under the AHCA, approximately 14 million people would come off the Medicaid rolls by 2026.

The second issue, and one not present in the previous version of the AHCA, is the so-called MacArthur Amendment, which would allow states to apply for permission to rescind some of the Affordable Care Act's regulations if they introduce policies designed to lower insurance premiums.

The CBO found that about one-third of the US population lives in states that would most likely make "moderate changes" to regulations under the MacArthur Amendment and about one-sixth lives in states that would make more extensive changes.

Christine Eibner, a health economist for the Rand Corporation, said that while there was a lot of uncertainty about how states would change regulations, it was reasonable to think state legislators would be under a lot of pressure to cut back on so-called essential health benefits, or certain conditions that insurers are required to cover, if other states are able to show that doing so brings down premiums. If that happens, substance-abuse treatment is viewed as the benefit "most at risk" to be cut, Eibner told Business Insider.

Approximately 1.84 million people in the US are receiving treatment for substance-use disorders or mental illnesses through the Medicaid expansion or the ACA's individual insurance marketplace, according to research conducted by Richard Frank, a professor of health economics at Harvard Medical School, and Sherry Glied, a dean at New York University. All of those people would be at risk of losing the approximately $5.5 billion paid out for treatment through those two avenues of insurance.

A 2017 Health and Human Services report found that approximately 34% of individual-market insurance plans did not cover substance-abuse treatment before the Affordable Care Act. Under the AHCA, a similar number would most likely either not cover treatment or begin underwriting substance-use disorder as a preexisting condition for thousands of dollars in premium surcharges, making insurance prohibitively expensive, Frank told Business Insider.

Eibner said the individual market wasn't the only place where treatment coverage would be affected. While she said employer-sponsored insurance would most likely continue to cover treatment, she expected Medicaid programs in states rolling back regulations related to the essential health benefits to cut substance-abuse treatment coverage as well.

Amendments to the AHCA allocate $15 billion over nine years and $8 billion over five years, respectively, to offset some of the costs to consumers if states waive benefits like substance-abuse treatment coverage and coverage for Americans with preexisting conditions. Frank found in his preliminary calculations, however, that those funds would be exhausted many times over in just a few short years just to pay for treatment for opioid-use disorder and serious mental-health conditions, leaving aside the myriad other conditions those funds are supposed to help cover.

Gary Mendell, the CEO of Shatterproof, a national nonprofit working to end the opioid crisis, has come out fervently against the bill.

"It's unbelievable that in the middle of a crisis our legislators would even consider reducing access to insurance for those needing treatment for substance-use disorder," Mendell told Business Insider.

While Mendell said he had engaged with the Trump administration over its ongoing commission dedicated to tackling the opioid crisis, he said that if the AHCA were signed into law, the administration and Republicans would have "zero credibility" in trying to fix the crisis because of how many people would be likely to lose access to treatment.

An analysis conducted by Eibner and Christopher Whaley, a policy researcher at Rand, found that in places that waive substance-treatment benefits, the out-of-pocket cost for consumers who use those benefits could rise by $1,333 a year. For "high-need" consumers, like those who need an in-patient stay at a treatment facility, out-of-pocket costs could rise to $12,261 a year.

"This assumes people still continue to use treatment," Eibner said. "Some may not seek it at all if it becomes too expensive."

Mendell said the AHCA would make substance-abuse treatment prohibitively expensive and, in particular, medication-assisted treatment, or MAT.

Considered by many experts to be the "gold standard" for overcoming opioid addiction, MAT uses prescription medications like buprenorphine or methadone to reduce cravings, allowing patients to work on the underlying issues leading to their substance use without the constant pressure of withdrawal.

Because of its promising results, MAT has gained bipartisan support in statehouses and on Capitol Hill, but it's expensive and remains difficult to access.

Health and Human Services Secretary Tom Price said in West Virginia earlier this month that MAT amounted to "substituting one opioid for another," a claim almost universally rejected by scientific, medical, and treatment communities. Mendell went so far as to call Price's statement a "dangerous comment that perpetuates misinformation."

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ALTOONA, Iowa — Lowering expectations, Iowa's two Republican senators say the long-promised repeal of "Obamacare" is unlikely, and any final agreement with the Republican-controlled House is uncertain.

The comments Tuesday by Sens. Chuck Grassley and Joni Ernst come as the Republican-controlled Senate moves forward on its work to dismantle the 2010 healthcare bill, officially known as the Affordable Care Act, while facing conflicting demands within their own party and lockstep Democratic opposition. Both senators are active players in the healthcare debate.

"You can't repeal it in its entirety," Ernst told reporters after a joint appearance with Grassley in suburban Des Moines.

It was a frank admission from loyal conservatives representing a state Republican Donald Trump carried in November.

The Senate's filibuster rule means that Republicans — who control the Senate with 52 seats — can't repeal the entire law.

"You've got to have 60 votes, and we don't have 60 votes at this point," Grassley said.

Grassley, in his seventh term, is a senior member of the Senate Finance Committee, which oversees the law's tax and Medicaid provisions. Ernst, elected in 2014, says she has been part of an informal GOP healthcare working group's discussions.

"As much as I'd love to go back and scrap the whole darn thing, we're simply unable to do that," Ernst said.

Other Senate rules permit the GOP majority to repeal portions of Obamacare without Democratic support but render other parts of the law off limits.

"That just allows us to tinker around the edges," Ernst earlier told Eric Borseth, an Altoona, Iowa, businessman who implored her to "get rid of that monstrosity."

What Grassley and Ernst did not mention are divisions within the Republican caucus in the Senate. Getting every Republican on board is proving arduous.

House Republicans passed a measure May 4 axing major parts of the Affordable Care Act, including hundreds of billions in extra Medicaid money that 31 states now receive for expanding to cover more lower-income Americans under the federal insurance program.

Such provisions, as well as the nonpartisan Congressional Budget Office's estimate that 23 million Americans would lose health insurance, make the House bill a nonstarter with several Republican senators.

Erasing President Barack Obama's healthcare law was a top promise of Trump during his presidential campaign and by congressional GOP candidates since its 2010 enactment.

But writing legislation that can pass with only Republican votes has proved agonizing.

House Speaker Paul Ryan canceled a March vote after opposition from party conservatives and moderates would have sealed its defeat, and the two wings of the GOP spent weeks blaming each other for the bill's demise. The House subsequently passed it by a narrow margin.

Ernst says the Senate will be able to make individual changes to Obama's law where only a simple majority vote is required.

For instance, she mentioned changing mandatory healthcare benefits required by insurers as ripe for Senate action.

Ernst stopped short of saying whether any legislation passed in the Senate would be accepted by the House.

"We will be working with the House," she said.

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Over the past couple of years there has been a mystery in the Iowa individual insurance market.

According to Blue Cross Blue Shield insurer Wellmark, there was a patient in the state's Affordable Care Act (Obamacare) exchanges who required $1 million a month in care.

This staggering $12 million in care each year was distorting the insurer's exchange business and forcing it to raise premiums across the exchange rapidly.

While the identity of the patient has not been revealed — rightfully so — a Wellmark executive did tell a Rotary club meeting that the person was a teenage boy with hemophilia, a genetic disorder that prevents blood from clotting, according to the Des Moines Register.

The story is heartbreaking, but it also has implications for the insurance market in the state.

The Wellmark executive told the meeting that the high costs were causing the insurer to raise premiums for the broader system, and the case reportedly was one of the reasons that Wellmark decided to pull out of the Iowa exchanges for 2018.

On a broader scale, this one case also shows why Obamacare's exchanges are facing problems — and why they have been saviors for many sick Americans.

Needed changes

This particular case is special, according to the Des Moines Register. The cost of care for most hemophiliacs tops out at $1 million annually (which is still incredibly costly). This case is an extreme example of the problems facing the Obamacare markets.

Obamacare mandated that insurers cover people even if they had preexisting conditions that insurers previously could use to deny coverage. According to Larry Levitt, a senior vice president at the nonpartisan health-policy think tank The Kaiser Family Foundation, this naturally led to problems.

"Of course making insurance more accessible for people with preexisting conditions has also created challenges for the stability of the individual insurance market," Levitt told Business Insider. "Covering the cost of very expensive patients raises the potential need for a reinsurance pool of some sort that existed in the first three years of the ACA and is part of the [American Health Care Act]."

Reinsurance is a policy that provides some federal funding to offset insurers' higher costs incurred from covering a sicker pool of patients.

The Iowa case also fits in with the trend of an increased number of older and sicker people signing up for ACA plans than originally expected since the exchanges came online.

In turn, premiums increased dramatically and insurers suffered substantial financial losses. Losses were so great at some insurers — especially those who mismanaged their plan structures — that they decided to leave these markets.

Levitt also said that a smaller market like Iowa's is even more problematic because there are fewer healthy people in the risk pool to offset the cost for an insurer such as Wellmark.

While these issues certainly need to be fixed in order to provide a more stable market for everyone in the exchanges, the story also gives a strong example for why Obamacare has been a success as well.

Success story

It is apparent that, from the insurer's side of things, the structure of the Obamacare markets presents a substantial issue when facing such high expenses. From the patient's side of things, however, the ACA is likely a godsend.

As pointed out by Levitt, some of the regulatory changes in Obamacare most likely saved the patient's family from serious financial stress and possibly serious health consequences.

"An expensive patient like this would have faced any number of challenges getting and affording health care before the ACA," Levitt told Business Insider on Thursday. "Such an expensive condition would be a whopping preexisting condition, and no insurer would have offered him insurance."

The community rating, a provision of Obamacare, obligates insurers to price premiums the same for people of the same age in the same area. This prevented people with preexisting conditions from being charged more than healthy people and getting priced out of the market.

Without that provision, an insurance company could raise premiums for a sick patient substantially to offset some of their costs, but the price could be so high that it would be financially crippling for the patient's family.

Additionally, the ACA eliminated lifetime limits for insurance plans. Before the ACA, insurers could set a cap on how much they would pay out to a patient over the course of their life.

"Annual and lifetime limits on benefits were common in the individual insurance market and in employer plans before they were prohibited by the ACA, and this patient would have blown through such limits quite quickly," Levitt said.

So, pre-ACA, the massive financial burden for this patient would have likely fallen on the family.

The Iowa case serves as a reminder of the real human impact of policy changes made in Washington at the same time the Senate deliberates on its own version of a healthcare bill.

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Medica Health, Nebraska’s last remaining Obamacare compliant individual insurance provider, has not yet decided whether it will continue to offer plans next year, according to the Omaha World Herald.

Should Medica join the ranks of providers that have left the state’s Obamacare exchanges, some 100,000 Nebraskans will be left without an option for Obamacare insurance.

Individuals looking for policies not connected with an employer or government sponsored plan will be left with no options, leaving them exposed to fines imposed under the individual mandate clause of Obamacare.

“Things are still changing daily,” Geoff Bartsh, vice president for Medica’s individual and family business told the Omaha World Herald. “We’re still looking at changes and will continue to evaluate things. We are still planning to participate in the Nebraska market for 2018. We haven’t made any final decisions on that yet.”

Bartsh’s statements were triggered by an announcement Thursday that Blue Cross Blue Shield of Nebraska will discontinue its last two Obamacare compliant individual health plans.

Losses from the two plans, called Bronze and Catastrophic, could reach $12 million this year and would continue next year even if premiums increase by 50 percent or more, Dale Mackel, Blue Cross executive vice president told the Omaha World Herald.

The Omaha-based company discontinued most of its Obamacare compliant individual plans for this year but left the Bronze and Catastrophic plans in place in an attempt to provide some access to individual coverage. The company hoped it would be able to at least break even on the plans but instead “we just continue to see the claims costs outpace premiums,” Mackel said.

“It’s just left us at a point where we feel like the best decision for our members, to remain stable and secure for all of our members, is to exit that portion of the business,” he said.

The company faced significant problems due to a lack of young, healthy people enrolling in their Obamacare plans, a problem familiar to many Obamacare providers throughout the country.

The risk pools on the Blue Cross’ remaining Obamacare plans were not diverse enough, as five percent of enrollees were responsible for 74 percent of the claims on the Bronze plan and 2 percent of the members were responsible for 59 percent of the claims on the Catastrophic plan.

Mackel explained that if Blue Cross left the two plans in place for next year premiums would increase by more than 50 percent on top of the 50 percent increase in place for this year.

Cynthia Cox, a deputy director of the Kaiser Family Foundation, a health care focused policy think tank, told the Omaha World Herald that its possible Medica could remain the only Obamacare compliant provider but they would face the same issues that plagued Nebraska’s Blue Cross affiliate.

“Medica doesn’t have the same kind of presence or history that the Blue Cross Blue Shield affiliates have,” Cox said. “It would be difficult,” for the company to remain on the state’s Obamacare exchanges.

SEE ALSO: Anthem weighing Obamacare individual market in each state

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We may be roughly halfway through 2017, but insurance companies are already showing just how much President Donald Trump's policies could rock the Obamacare market.

Insurers have submitted their 2018 plans in seven states and Washington DC for the Obamacare individual insurance exchanges, giving us the first glimpse of how they are digesting the outlook for the healthcare industry under Trump.

Over the past two weeks, two insurers have made it clear just how Trump's policies could cause healthcare costs for average Americans in these exchanges to increase by more than they would otherwise.

In Pennsylvania, Insurance Commissioner Teresa Miller announced on Thursday that the premium for a baseline Obamacare exchange plan would increase by an average of only 8.8% for 2018 compared to this year. This is lower than the 10.5% increase between 2016 and 2017.

But Miller warned that premiums could go much higher if Trump makes just a few policy changes. According to Miller, if Trump announces he will stop enforcing the individual mandate that compels people to buy coverage, premium requests from insurance companies would increase by an average jump of 23.3%.

Additionally, if Trump stops making cost sharing reduction (CSR) payments, insurers would ask for a 20.3% increase on average. CSR payments offset the cost for insurers of providing lower out-of-pocket costs to poorer Americans. Health policy experts have said the payments are critical and without them, Trump's predictions of a "collapse" in the market could come true.

If both changes are made, insurers would ask for a 36.3% increase, according to Miller.

"I sincerely hope that Congress and the Trump Administration do not take action that could negatively impact the progress we have made in Pennsylvania," Miller said in a statement announcing the rates.

Similarly, in North Carolina, Brad Wilson, the CEO of Blue Cross Blue Shield North Carolina (BCBS NC), said that the company was forced to jack up their requested premium due to the uncertainty over the CSR payments and other changes form the Trump administration.

Due to uncertainty over the CSRs, the company requested an increase of 22.9% for the 2018 plan year. BCBS NC said they would have requested a 8.8% raise if not for the payments' murky future.

"The failure of the administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower," Wilson told The Washington Post. 'That will impact hundreds of thousands of North Carolinians."

In fact, Wilson said that the market in 2017 was looking solid.

"It’s still early and our numbers for the year run about 30 to 45 days behind. But the analysis underway so far in 2017 appears to show stability in the market in terms of price, utilization, and the customer base,"the CEO told Vox.

Many health policy experts projected that the large jump in premiums for 2017 was a one-off issue as insurers adjusted their plan costs to the relative health of the market and the exchanges became fully phased-in.

It appears in Pennsylvania and North Carolina the exchange markets were close to being stabilized, if not for the uncertainty from the Trump administration.

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Senate Republicans are closing in on their own version of a healthcare overhaul, according to a new report.

The Wall Street Journal's Stephanie Armour and Kristina Peterson reported Monday that Senate GOP leadership will present members with options for the bill to repeal and replace the Affordable Care Act, better known as Obamacare, during a regularly scheduled lunch on Tuesday.

Among the options, according to the Journal, will be provisions to stabilize Obamacare's individual insurance exchanges and a longer phase out of the ACA's federal funding to expand Medicaid.

The stabilization of the insurance exchanges could also be a separate bill, according to the report. Such a move would allow the Senate more time to craft their own healthcare overhaul.

Additionally, the report said Senate GOP leaders hope to write a bill and get it to the Congressional Budget Office to be scored by the end of the week. Leaders also want a vote on a bill before the week-long July 4 recess.

Senate GOP members have said they are planning to write their own version of a bill, diverging from the House's American Health Care Act. The expedited process is key to getting a healthcare bill done before the month-long August recess. A crowded legislative calendar in September could derail any reform for months.

Passing a healthcare bill in the Senate is also a politically fraught effort given that Senate Majority Leader Mitch McConnell can only afford to lose two votes on the bill given the reconciliation process the Republicans are using.

Currently, more moderate members of the Senate GOP are pushing for more funding for Medicaid and added funding for tax credits to help people purchase coverage. On the other hand, conservative members of the group, such as Sen. Ted Cruz and Rand Paul, are pushing for deeper funding cuts and a more complete repeal of Obamacare.

Read the full report at the Wall Street Journal»

SEE ALSO: Insurance companies have made it crystal clear how Trump could send Americans' healthcare costs soaring

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Anthem on Tuesday announced it would not participate in the individual health-insurance exchanges in Ohio for the 2018 plan year. That could leave 20 counties in the state without any plans on the marketplaces established by the Affordable Care Act, the healthcare law better known as Obamacare.

In a statement to Business Insider, Anthem cited "continual changes in federal operations, rules, and guidance" as its primary reason for exiting the marketplaces.

The insurer said disruptions in the market because of possible policy changes from the Trump administration and lawmakers on Capitol Hill led to the decision.

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."

According to the Ohio Insurance department, the move would leave 18 counties without insurance based on preliminary filings for 2018. Based on 2017 plan offerings, this means that at least one new insurer is planning to move into each Mercer and Auglaize counties according to Cynthia Cox, associate director at health policy think tank The Kaiser Family Foundation.

"Anthem’s exit from Ohio could be the tip of the iceberg," Cox told Business Insider in an email.

"Their reasons for leaving don’t appear to be specific to Ohio, rather about political and regulatory uncertainty coming from the White House and Congress. If Anthem leaves the market nationally, there could be hundreds of thousands of people without any exchange insurer."

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 backup 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, and Iowa. In other states, insurers requested dramatic increases in the cost of premiums because of the political uncertainty surrounding the law.

Insurers, including Anthem, have singled out Obamacare's so-called cost-sharing reduction payments as a source of instability. The payments, which the executive branch is currently funding (a move that is the subject of a lawsuit), help offset the cost for insurers of providing cheaper coverage to low-income Americans. 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," the statement said.

Anthem did not specify its participation in other states where it offers marketplace plans. According to Cox, if Anthem exits marketplaces nationwide, it would leave 275,000 Americans with no insurer offering a plan in their area.

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Senate Republicans appear to be running headlong into a healthcare bill that may not pass.

Reports say GOP leaders are looking for an end to the debate over their proposed healthcare overhaul during 2017 — one way or another.

Senate Majority Leader Mitch McConnell and leadership are presenting their conference with options for their version of a healthcare bill at a regularly scheduled meeting on Tuesday, according to those reports. The Senate is expected to essentially start from scratch in creating a bill designed to repeal the Affordable Care Act, the healthcare law better known as Obamacare, after it seemed unlikely that the House repeal bill, the American Health Care Act, would pass through the Senate.

It appears that leadership wants to make major decisions on aspects of the bill — like funding for Medicaid expansion and tax credits for Americans to purchase insurance — in short order to get the bill a vote by the end of June.

Stricter rules in the Senate for the budget reconciliation process require that the bill shave at least $133 billion from federal deficits, meaning the bill will need to be scored by the Congressional Budget Office.

Based on that timeline, and roughly a two-week turnaround for the CBO, leaders are pushing to get the legislative text of the bill done by the end of the week, according to Politico's Jennifer Haberkorn and Burgess Everett.

Politico's Dan Diamond, citing a source close to McConnell, reported that the majority leader wanted to get the healthcare debate settled so the Senate could focus on other issues like taxes and funding the government in the fall.

Given recent statements from several Republican senators, it looks as if failure for the bill is a real possibility.

"I don't think this gets better over time," Sen. Roy Blunt, a Republican from Missouri, told Politico. "So my personal view is we've got until now and the Fourth of July to decide if the votes are there or not. And I hope they are."

"Just listening to the debate over the past few weeks, I think cobbling together a bill that could get 50 votes is going to be a challenge, but you never know," said GOP Sen. Susan Collins, a moderate member of the caucus.

"I don't think there will be" a healthcare bill, Sen. Lindsey Graham of South Carolina told Bloomberg on Monday. "I just don't think we can put it together among ourselves."

And Sen. Richard Burr told a local North Carolina news station last week that he didn’t expect a healthcare deal to get done in 2017 and was focusing on actions designed to stabilize the individual insurance market instead.

"It's unlikely that we will get a healthcare deal, which means that most of my time has been spent trying to figure out solutions to Iowa losing all of its insurers, to Tennessee losing theirs, to North Carolina only having one insurer in 95 out of 100 counties," Burr told WXII News in Sanford, North Carolina, last Thursday.

A GOP aide had a somewhat more painful analogy for the possibility of the healthcare vote failing, according to Caitlin Owens of the news website Axios.

"It's like a root canal,"the aide told Axios. "Best to get it over with and move on to things Republicans are good at."

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Anthem, one of the country's big five public health insurers, announced that it is pulling out of Ohio's Affordable Care Act individual insurance marketplace for the 2018 plan year on Tuesday.

The move will leave between 18 and 20 counties in the state with no ACA, also known as Obamacare, insurer for 2018 depending on other insurers' plans.

The Ohio counties joined a large swath of eastern Missouri that lost coverage after the exit of Blue Cross Blue Shield Kansas City in May.

While this is certainly concerning for Ohio's ACA exchanges, it could also represent the opening of the floodgates for bad news for the rest of the country's markets.

An exchange with no insurer is a seriously worrying prospect for any insurance market. People on the exchange currently would likely lose their coverage next year if no other insurer steps in. While it is likely they would not have to pay the ACA's tax penalty, these people would not see the benefits of coverage.

The Anthem exit in Ohio is especially worrying, however, given the massive swath of the country in which it is the sole insurer in the exchanges, according to Cynthia Cox, associate director at nonpartisan health policy think tank The Kaiser Family Foundation.

"Anthem’s exit from Ohio could be the tip of the iceberg," Cox told Business Insider on Tuesday. "Their reasons for leaving don’t appear to be specific to Ohio, rather about political and regulatory uncertainty coming from the White House and Congress. If Anthem leaves the market nationally, there could be hundreds of thousands of people without any exchange insurer."

In a statement to Business Insider, Anthem cited a number of uncertainties that could impact the market coming from the Trump administration and Congress.

"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," said the statement.

Given Anthem's political worries, there is a strong possibility the insurer could pull out of the other 13 states where they provide exchange plans if issues aren't resolved in Washington by the time the company has to submit its 2018 plans in late June.

For many of these states, this could leave areas with no insurers, triggering the worst case scenario for large swaths of the country. For example, Anthem remains the only insurer in 72 counties in Missouri and if the insurer decides to pull out, this could leave as many as 100,000 people without an insurer, according to Cox. Anthem also represents the final choice for consumers in Georgia, Colorado, Kentucky, Virginia, Nevada, and possibly Iowa.

Looking beyond just Anthem, the move also represents a worrying trend for Blue Cross Blue Shield plans nationwide. Anthem is the largest operator of these plans, but independent BCBS companies operate in all 50 states and, according to Cox, are the last insurer in many places. If the Anthem exit in Ohio and the BCBS Kansas City exit in Missouri are just the first in a wave of exits for BCBS insurers, it could be devastating for the market.

While Anthem has not laid out plans for these markets for 2018, and there are still a few weeks before the company and other insurers have to have their plans locked in place, the Ohio exit is concerning.

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Senate Republicans may just save Obamacare — right before they tear it up.

According to a report from Jennifer Steinhauer and Robert Pear at the New York Times, Republicans are considering a measure that would help stabilize the Affordable Care Act's individual insurance markets for the short-term during their drafting of a bill to repeal and replace the law.

As part of crafting their healthcare bill, the Times reported, Senate Republicans are considering funding the cost sharing reduction (CSR) payments that are vital to ensuring the stabilization of the individual insurance market.

The issue at hand is the legality of funding of the CSR payments. These funds help to bring down out of pocket costs for lower income Americans and make plans affordable.

The funds are currently dispersed via the executive branch, a move that has been challenged by the Republican-led House of Representatives. While the Obama administration lodged an appeal after a judge ruled that the CSR payments from the executive branch were illegal, there is an open question of whether the Trump administration will continue the appeal and fund the CSRs.

If these payments are not made, insurers have said they will need to drastically increase premiums in 2018 to compensate and health policy experts warned that it could cause the ACA exchanges to collapse.

In order to combat the possibility of dramatically higher prices or dropped coverage for millions of Americans, the Senate is discussing allocating these funds legally through a congressional appropriation. It is unclear whether this would happen as part of the larger healthcare-reform bill, or as some GOP senators have suggested, a separate bill that would likely move faster than the full-scale overhaul.

GOP Sen. Rob Portman of Ohio said that the Senate needed to make sure an insurance market collapse did not happen. "The administration has delayed a decision from month to month,"he told the Times."We need to deal with it as soon as possible to provide some stability in the market."

On May 22, the House and Trump administration said they were delaying a court update on whether or not the appeal will go ahead for another six months. Additionally, the Trump administration has only committed to funding the CSRs through the end of May.

This uncertainty has led a handful of insurers to announce that they are pulling out of the ACA exchanges for 2018 over the past two months, further clouding the outlook for the individual insurance markets next year.

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Even for someone right in the thick of the action, the details of the Senate's rewrite of the GOP healthcare bill seems like a mystery.

Sen. Claire McCaskill, a Democratic senator on the Senate Finance Committee, railed against what she viewed as a secretive process around the healthcare legislation as Republican leaders move toward a vote before the July 4 recess.

During a hearing with Health and Human Services Secretary Tom Price, McCaskill sparred with GOP Sen. Orrin Hatch, the chair of the committee, for not having a more open process in writing the bill.

McCaskill first asked Hatch if there was going to be a hearing in the Finance Committee on the bill, given that it could affect trillions of dollars in healthcare spending. Hatch, after conferring with an aide, did not commit to a hearing but said Democrats were welcome to give ideas on the bill.

McCaskill countered by saying this was not how the Affordable Care Act, better known as Obamacare, was shaped into law. Republicans have continually criticized the ACA over the past seven years for being passed by Democrats in secret and rammed through on a partisan vote.

McCaskill then went after the Republicans for an alleged lack of communication and public transparency on the bill. McCaskill said (emphasis added):

"Dozens of Republican amendments were offered and accepted in that hearing process and when you say you're inviting us — and I heard you Mr. Secretary [Tom Price] that you want our support — for what? We don't even know. We have no idea what is being proposed. There's a group of guys in a backroom somewhere making these decisions. There were no hearings in the House. And listen, this is hard to take because I know we made mistakes on the Affordable Care Act, Mr. Secretary, and one of the criticisms we got over and over again was that the vote was partisan. Well, you couldn't have a more partisan process than what you're engaged in right now."

McCaskill said the reason for the secretive process is obvious. Since Republicans are using the budget reconciliation process, they only need a simple majority to pass the bill, and no need for Democratic votes.

But McCaskill charged that amounts to a violation of Senate Majority Leader Mitch McConnell's promise to use regular order to pass bill, which would include more hearings and public testimony. Said McCaskill:

"I am stunned that that is what Leader McConnell would call regular order, which he sanctimoniously said would be the order of the day when the Republicans took the Senate over. We are now so far from regular order, new members don't even know what it looks like. I know that doesn't make you happy Mr. Chairman or Sen. [Chuck] Grassley, because you've been in the Senate so long you know the value of the hearing process and the amendment process."

In the end, there is little the Democrats can do in the minority to stop the process to continue on its current path. But McCaskill made an appeal to Hatch's and Grassley's work on the Affordable Care Act. 

"Both of you had amendments that were put in that bill, as did other members of this committee," McCaskill said. "I want that opportunity. Give me that opportunity, give me the opportunity to work with you. That's what is so discouraging about this process."

Watch the McCaskill's full statement below:

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As Senate Republicans hash out what their healthcare bill should look like, senators are discussing a long "glide path" for the Medicaid expansion — instead of ending it abruptly in 2020, the federal government would phase down its payments to state governments gradually, perhaps through 2027.

The idea is that the extra time would help states find the money to pay for more of expanded Medicaid themselves, should they choose to do so. Republican senators from states that have expanded Medicaid, like Rob Portman of Ohio and Shelley Capito of West Virginia, have insisted on it.

But in practice, this policy choice would set up the next six congressional elections to be fought, in large part, over the issue of Medicaid.

Even though the American Health Care Act cuts nearly a trillion dollars out of Medicaid over a decade, and even though a majority of the loss of insurance coverage the CBO expects due to the bill results from those Medicaid cuts, the political discussions of the bill have tended to focus more on its effects on health insurance sold in the individual market.

But if the AHCA goes from a proposal to public policy, Medicaid will become the bigger deal, politically. As the "glide path" proceeds, and the federal government starts cutting payments to states for Medicaid, about 14 million people will lose health insurance coverage. Hospitals will close. State budgets will be squeezed.

Only some of the problems that would emerge in the healthcare market over this period would actually be due to the AHCA. But as Republicans should know from their war of attrition against Obamacare, the first rule of healthcare politics is that if you make changes, you get blamed for everything that happens.

This is also a reason to expect that main policy effects of the AHCA may never materialize, even if the law passes.

Most of the law’s effects would be delayed at least until 2020. In the intervening time, the main change is likely to be the abolition of the individual insurance mandate. This change would prompt insurers to raise premiums, which would make the law even less popular than it is now, as a mere bill.

In 2020 and later, the AHCA might lead to lower premiums for many healthy customers, because health insurance markets with medical underwriting would make it possible for consumers to buy policies that give them credit for their good health, or that exclude benefits they don’t expect to use. (Such medical underwriting would also make it extremely expensive or impossible for people with chronic illnesses to buy health insurance, or even for women of childbearing age to buy plans that cover pregnancy, but then, all public policy is trade-offs.)

In 2018 and 2019, those lower premiums wouldn't have materialized for anyone, and so the 2018 congressional elections would be fought in a political environment driven by high insurance rates for 2018 (which Republicans would surely, if not effectively, seek to blame on Democrats) and even higher announced insurance rates for 2019.

The AHCA is already a weight on Republican congressional candidates now. One can only imagine how voters will feel about it once they actually feel its effects.

The passage of Obamacare was not the end of the politics of Obamacare; it was only the beginning. The law helped Republicans win back the House of Representatives in 2010, and if Mitt Romney had won the presidential election in 2012, they would likely have been able to stop the law before most of its provisions went into effect.

Similarly, if the AHCA becomes law, that will be only the beginning of the fight over the AHCA.

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Senate GOP members are close to finishing the legislative text of their bill to repeal and replace Obamacare, but the public won't get to see it anytime soon, Axios' Caitlin Owens reported Monday.

The bill will be sent to the Congressional Budget Office to receive a score some time in the next few days, according to Axios, but the text will not be posted publicly. 

A GOP aide told Axios that not releasing the text of the bill is because "we aren't stupid."

The American Health Care Act, House Republican leaders' legislation aimed at repealing and replacing Obamacare, received low marks from the public upon its release in March. According to a poll by Quinnipiac University, the AHCA as drafted by the House received a 21% approval rating and 56% disapproval.

The secrecy is a marked contrast to years of Republican attacks on the process surrounding the Affordable Care Act, the law colloquially known as Obamacare, for what they called "backroom deals" out of the public eye.

GOP Senate leaders have suggested they plan to vote on the bill before the week-long July 4 recess.

Read the full report at Axios»

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Centene Corporation on Tuesday said it would step into some of the most desperate Obamacare markets to provide much-needed coverage options.

The Medicaid-focused insurer announced that it would start selling plans on the Affordable Care Act's individual health-insurance exchanges in Missouri, Kansas, and Nevada in 2018. The company has also said it will expand its footprint in Florida, Georgia, Indiana, Ohio, Texas, and Washington.

The expansion comes after several insurers said over the past few weeks they were leaving the ACA exchanges in various states. In fact, 25 counties in Missouri are facing the possibility of having no insurers available in the exchanges after the exit of Blue Cross Blue Shield of Kansas City.

It is unclear whether Centene will enter those counties. CEO Michael Neidorff said the insurer was committed to providing the Obamacare plans despite lingering uncertainty from Washington that has taken a toll on the exchanges.

"Centene recognizes there is uncertainty of new healthcare legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive healthcare services to our members," Neidorff said in a statement announcing the move.

The company also said in the statement that it was "committed to working closely with regulators and policymakers to collaborate on the actions that stabilize the market."

Medicaid-focused insurers have had more success on the exchanges, health-policy experts say, because the makeup of the Obamacare exchanges bears more similarities to the Medicaid market and requires low-cost plans.

According to Centene, the number of Obamacare enrollees it insured more than doubled from 537,200 in December to 1.2 million this past March.

SEE ALSO: 'We aren't stupid': Senate Republicans are keeping their healthcare bill secret for now

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President Donald Trump vented his frustration with the press and the courts in a series of tweets Tuesday morning in which he accused both institutions of deliberately undermining his agenda.

The tweets reflected the president's well-known opinions on the news media and the federal court system, each a repeat target of his online attacks.

At 6:35 a.m. ET on Tuesday, Trump accused the news media of publishing intentionally inaccurate stories about him and his administration in service of an "agenda of hate."

While not citing any specific articles or evidence of falsehoods, he followed up an hour later with an attack on the 9th US Circuit Court of Appeals, which on Monday became the second federal appeals court to rule against his administration's blocked executive order seeking to limit travel to the US from several majority-Muslim countries.

The court rested its decision in part on a tweet that Trump posted on June 5 in which he argued that the US needed a "travel ban" targeting certain "dangerous countries" to protect national security. The appeals court ruled that the ban unlawfully discriminated against people on the basis of their nationality and that the government did not show that these people would harm US interests.

On Tuesday, Trump said the court's decision was expected, and he ended his tweet on the subject with "S.C.," presumably an abbreviation for the Supreme Court. Earlier this month, the administration appealed the 4th Circuit's May decision against the ban to the Supreme Court.

Trump moved on to his former presidential opponent Hillary Clinton in his next tweet, accusing former Attorney General Loretta Lynch of giving Clinton a "free pass and protection" during the investigation into her use of a private email server during her tenure as secretary of state.

Moving back to the media, Trump called for an apology from the press for its "incorrect" stories and said fake news was at "an all time high," though he again did not cite examples. And in another tweet concerning his Tuesday trip to Wisconsin, he commended the "Real News" for covering his administration's job-creation efforts.

In another morning message, the president wrote that Obamacare, the healthcare law officially known as the Affordable Care Act, had entered a "death spiral." As evidence, Trump cited a misleading statistic that 2 million Americans "just dropped out" of the program and argued that "Obstructionist Democrats" were preventing Republicans from repealing and replacing the law.

Trump mischaracterized a report published by the Centers for Medicare and Medicaid Services this week that found that 2 million people since January had not paid for Obamacare insurance plans for which they had signed up. Many of those people most likely aged into Medicare or began receiving insurance coverage through an employer.

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President Donald Trump took to Twitter on Tuesday to once again go after the Affordable Care Act, the law colloquially known as Obamacare.

Trump was apparently referring to a report from the Centers of Medicare and Medicaid Services released Monday. The report showed the number of people that signed up for insurance through the ACA's individual insurance marketplaces but did not enact those plans, or pay their premiums.

"2 million more people just dropped out of ObamaCare,"Trump tweeted."It is in a death spiral. Obstructionist Democrats gave up, have no answer = resist!"

According to CMS, 10.3 million Americans effectuated their coverage in February, meaning that they had paid their premiums to actually receive care. That was lower than the 12.2 million people that signed up for coverage during the 2016-2017 open enrollment period.

CMS Director Seema Verma, echoing Trump, used the study to make the case that this showed Obamacare's shortcomings.

"Consumers are sending a clear message that cost and affordability are major factors in their decision to cancel or terminate coverage," Verma said in a statement.

According to a CMS survey, the people that canceled or did not effectuate coverage typically had less financial assistance to pay for their plans and higher premiums than those who maintained their coverage.

The report also found that 46% of people who did not effectuate their coverage at all did so due to the cost of the plan.

At the same time, the report found that 49% of people who terminated their plan after paying for a month did so because they found coverage elsewhere, mainly through new employment or aging into Medicare.

The drop-off is a common theme of the exchanges in recent years, but the approach from the Trump administration to the numbers is different than in years past.

"The dropout rate is very similar to last year, with some people failing to pay their premiums or finding alternative coverage after signing up during open enrollment," Larry Levitt, senior vice president the Kaiser Family Foundation, told The Associated Press."What's new here is a new administration spinning numbers in a very different way from the last one."

Trump is visiting Wisconsin on Tuesday, when will give a speech on the current state of healthcare in the US and meet with "victims of Obamacare" during his visit, the White House said.

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