(Bloomberg) -- Concerned by the uncertain future of U.S. healthcare policy, Anthem warned it may hasten its retreat fromObamacare’s insurance marketplaces unless itsees a firm commitment from the government to fund the program.

Related: Bucking trend, insurer Centene expands ACAcoverage

Anthem had been an Obamacare stalwart, but ithas already moved to leave some states’ marketplaces that accountfor about 10 percent of its members under the health program.

Without assurance of funding of government subsidies that helppatients pay out-of-pocket costs, the company may further cut itsparticipation in the Affordable Care Act, Chief Executive OfficerJoseph Swedish said Wednesday.

“Some of our critical decisions will have to occur in arelatively short period of time,” he said on a conference call.“Time is of the essence for us to make the right decisions for themarkets we serve, the membership we serve, as well as with thecompany overall.”

Senate Republicans are pushing for an overhaul of the ACA, whichPresident Donald Trump vowed to repeal and replace during hiscampaign last year. Lawmakers voted Tuesday to open debate onrepealing the law, but the most comprehensive plan put forward byGOP leaders failed in an early vote, amplifying uncertainty overthe state of the market.

Narrower participation

Most other for-profit insurers have pulled back from Obamacare’smarkets after posting losses on health plans for individuals.

Anthem said in a statement Wednesday that it saw improvedmedical cost performance in its local group and individualbusinesses.

Anthem fell 2.6 percent to $186.58 at 10:11 a.m. New Yorktime.

Still, without the continued government subsidies, calledcost-sharing reduction payments, Anthem said it would need to boostrates for its ACA-compliant plans as much as 18 percent to 20percent. In some markets, Anthem would probably quit instead, thecompany told investors on a conference call.

“If we aren’t able to gain certainty on some of these itemsquickly, we do expect that we will need to revise our rate filingsto further narrow our level of participation,” Swedish said on thecall.

With about 1.5 million customers in ACA-compliant plans in 14states this year, Anthem is among the biggest insurers in theprogram. Still, that’s a small part of the company’s 40.4 millionmembers, who consist mainly of customers whose insurance isprovided by employers. Anthem also has about 6.5 million members inthe Medicaid program for the poor, a program that GOP lawmakershave targeted for cuts in some ACA-repeal proposals.

Drug benefits

Anthem recently scuttled a deal to merge with Cigna Corp. thatwould have made it the biggest U.S. health insurer, amid mountingchallenges to the combination on antitrust grounds.

The companies are embroiled in a legal dispute over who’s toblame for the failed deal and which company should pay the other a$1.85 billion breakup fee. In the meantime, Anthem is looking fornew ways to grow revenue and profits.

The company is also charting a course for how it will manage itsdrug benefits, after threatening not to renew a contract withExpress Scripts Holding Co. Anthem said that its requests forproposals for a new pharmacy benefits manager already suggest thatit can save more than $3 billion on drug costs.

Express Scripts said it received a request for a proposal fromAnthem and plans to respond. The pharmacy benefit manager, whichannounced a cost-cutting initiative Tuesday, said that it believesit’s still the best option for Anthem, its biggest client.

Express Scripts’ CEO Tim Wentworth said on his company’sconference call that he has had “an exchange of communicationsbetween myself and Joe Swedish,” Anthem’s chief executiveofficer.

Anthem’s adjusted profit was $3.37 a share in the secondquarter, Anthem said in a statement. That beat analysts’ averageestimate of $3.23 a share. Earnings excluding some items for 2017will be more than $11.70 a share, up from an earlier forecast ofmore than $11.60 a share.

Copyright 2018 Bloomberg. All rightsreserved. This material may not be published, broadcast, rewritten,or redistributed.