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Anthem Exits Ohio Obamacare Exchange, Raising Health Care Stakes

WASHINGTON — Anthem, one of the nation’s top insurers, pulled out of Ohio’s individual insurance exchange on Tuesday, citing low enrollment along with ongoing threats from the White House and Congress to cut off payments for low-cost plans.

The decision threatens to leave 20 counties with no insurers on Obamacare’s exchange, which cover people who don’t get plans through their employer or federal programs.

In a statement, the company said the “individual market remains volatile” and blamed an “increasing lack of overall predictability” along with the Cost Sharing Reduction payments (CSR), a delayed tax on high-end insurance plans and a “shrinking individual market” for the decision. Anthem sells plans in other states as well, including counties where it is the only insurer, raising the prospect that more customers could be left with no plans to buy in the 2018 enrollment period.

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Anthem's exit from Ohio's exchanges comes after a rash of similarly justified moves by insurers to raise premiums or pull out of markets, setting off a familiar round of finger-pointing. Republicans argued it showed Obamacare was faltering and must be replaced while Democrats said it was more evidence that Congress and the White House were sabotaging the insurance market.

Dueling statements by Ohio’s two senators illustrated the split.

Sen. Rob Portman (R-OH) said “the status quo on health care is unsustainable” and that “the Affordable Care Act has failed to meet the promises that were made to Ohio families.” At the same time, Sen. Sherrod Brown (D-OH) tweeted “the dangerous game Pres. Trump & GOP are playing just kicked 70k paying OH customers off their insurance & will keep raising prices.”

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President Donald Trump has openly threatened to withhold the CSR payments, telling The Wall Street Journal in April that the resulting chaos could pressure Democrats to negotiate a deal on health care. He added that he was torn because he didn’t want to see people “get hurt.”

House Republicans have sued over the payments, which they argue were improperly drafted, but they have declined to pass legislation that would resolve the dispute. Part of this may also be due to Trump’s erratic comments: Congress passed a spending bill in April thanks to public reassurances by the administration that it would make the payments while the lawsuit continued. But the president once again threatened to withhold them “anytime I want” in May.

Related: Obamacare: Five Things You May Not Know About the Health Care Law

The Affordable Care Act exchanges faced a significant dropoff in insurers and a rash of premium increases last year and Democrats concede fixes are needed to increase competition and lower premiums in underserved states. Some outside analysts reported the exchanges were stabilizing this year, however, while insurers and even some Obamacare critics say the uncertainty over the law poses an immediate danger. Sen. Susan Collins (R-ME), for example, has explicitly called on the White House and Congress to guarantee the CSR payments.

With deadlines arriving for insurers to submit premiums and to decide on their final participation in September, the market could be heading toward a tipping point that will leave many Americans paying higher premiums or without any insurers at all.

Even if insurers stay in the market, the nonpartisan Kaiser Family Foundation estimates insurers would have to raise premiums by 19 percent on average to make up for the CSR funding. That has both parties gearing up for a blame game, but no clear answer as to how Congress or the Trump administration will resolve the looming crisis.