Pointing out insurer exits has become a refrain for the president and Republican leaders in Congress, who are seeking a health care overhaul.
But the Centene news underscores that, while some local markets are struggling to attract insurers, much of the country remains appealing to them. Several of the companies that had difficulty making money seem poised to start breaking even, and other insurers, like Centene, have been able to turn a profit.
“It’s a good business for us,” said Michael F. Neidorff, the company’s chief executive. He said Centene had “done well” in the market and saw continued opportunity. While he would not say which counties Centene planned to enter, he said it was looking at places where other insurers had exited to see if it could offer plans. “We want to help out where we are able to,” he said.
The Trump administration itself may be playing a role in the current instability. Several insurers that have left the markets said they chose to do so, in part, because of uncertainty over administration policies. Mr. Trump has declined to say whether he will continue making payments to insurance companies to help them cover low-income Americans. And insurers also worry that he may decline to enforce the health law’s individual mandate, the penalty people face if they choose not to have coverage.
No insurer decisions about next year are final yet. “This market is still resilient, despite some of the uncertainty that is scaring away other insurers,” said Cynthia Cox, an executive at the Kaiser Family Foundation.
Centene has experience being the only insurer in a market. It was the sole carrier in Maricopa County in Arizona, a place forsaken by its competitors and at risk of having no insurer willing to offer coverage. The company said its experience in Maricopa was no worse than it was elsewhere.
Economists generally view such so-called bare counties as a good bet for insurance companies, which would face no competition and little resistance from local regulators if they charged high prices for coverage.
Centene, which covers 1.2 million people through the state marketplaces, is among the few national players to have established a robust business under the Affordable Care Act. The company is betting that it is flexible enough to take advantage of the turmoil in the market.
“Centene recognizes there is uncertainty” in the new health care legislation, said Mr. Neidorff in a statement announcing its decision.
Much of the uncertainty is causing insurers to propose much higher rates, but the vast majority of Obamacare marketplace customers receive federal subsidies to help purchase their coverage and would essentially not be harmed by any price increases. The large number of subsidized customers also help insulate an insurer from losses if it raises prices. “Subsidies prevent what might otherwise be a death spiral,” Ms. Cox said.
But as insurers make decisions about participation in next year’s markets, Congress continues to consider legislation that would undo substantial portions of the health law. The White House meeting with senators was an effort to encourage them to pass a version of the American Health Care Act, a bill that would reshape regulations and funding for the individual insurance markets, and make substantial cuts to state Medicaid programs.
The bill’s text has not been made public, but Senate leaders have said they hope to hold a vote on the measure by the end of July.
Democrats have assailed the effort as opaque and rushed. “They don’t want the American people to see how poorly they would do under this bill,” said Chuck Schumer, the Senate minority leader, in a news conference Tuesday.
Health care legislation that passed the House in May would result in 23 million fewer Americans having health insurance in 2026, according to the Congressional Budget Office, and could cause market failures in some states that would make insurance inaccessible to Americans with a history of health problems. Senators are discussing various changes to the bill, which could change its effects, though the basic architecture is expected to be similar.
The budget office, at least, suggests that the current markets are more stable than the House’s legislative proposal to replace them.
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