Anthem Inc.’s decision to quit offering Obamacare plans in much of Nevadawill leave large parts of the state without options on the healthlaw’s exchanges.

The health insurer, a one-time Obamacare stalwart, hasaccelerated its retreat in recent weeks, blaming in part theuncertainty about the fate of the health law in Washington formaking it difficult to come up with plans and calculatepremiums.

In Nevada, officials including Republican governor BrianSandoval called the situation a crisis Wednesday night. Anthem willnow offer plans on the Affordable Care Act’s exchange in just threeof the state’s more-populated counties, after previously sellingcoverage statewide. That leaves about 8,000 people in 13 countiesand Carson City without access to Obamacare health plans and thegovernment subsidies that often come with them, according to thestate’s Silver State Health Insurance Exchange.

“I consider this a health care crisis for rural Nevada,” HeatherKorbulic, executive director for the exchange, said in a statement.“My staff and I are doing everything within our control andinfluence to secure resources for consumers.”

Major role

Sandoval and Nevada GOP Senator Dean Heller are playing amajor role in the debate over the future of Affordable Care Act,both opposing the embattled Senate health bill that is now on holduntil after the July 4 recess. Republicans in Congress arestruggling to agree on a way to fulfill their campaign promise toundo Obamacare, which contributed to the deterioration of theindividual market. And Heller was one of the key senators whoseopposition forced Senate Majority Leader Mitch McConnell to delay aplanned vote on the bill this week.

Under the ACA, Nevada was among 31 states that broadenedeligibility for their Medicaid programs to more low-income people.Sandoval said Wednesday that the Medicaid expansion and subsidizedhealth plans helped to dramatically reduce uninsured rates, andthat his administration is working to craft a safety net forindividuals in the empty counties.

“Lack of coverage in rural Nevada will set back years of work toreduce the uninsured rate throughout our state,” he said in thestate exchange’s statement. “I have communicated the news of thiscrisis to U.S. Health and Human Services Secretary Tom Price.”

‘Increasingly difficult’

Anthem still has a larger presence in the ACAthan major rivals like Aetna Inc., Humana Inc. and UnitedHealthGroup Inc., which have all largely quit selling Obamacare plansaltogether. Because Anthem has been a big player in Obamacare andhas filed to stay in markets including Colorado and Virginia, itsrecent decisions to withdraw from some states have createdupheaval. Nevada is following Wisconsin, Indiana and Ohio,states where Anthem plans to exit Obamacare markets almostentirely, leaving empty counties in its wake.

“Planning and pricing for ACA-compliant health plans has becomeincreasingly difficult due to a shrinking and deterioratingindividual market, as well as continual changes and uncertainty infederal operations, rules and guidance, including cost sharingreduction subsidies and the restoration of taxes on fully insuredcoverage,” Anthem said in a statement Wednesday night.

In Nevada, the insurer will offer on-exchange plans in Clark,Nye and Washoe Counties. Clark, the state’s most-populated countyby far, is home to Las Vegas. About 81,000 people in those threecounties bought Obamacare plans for this year, compared to the8,000 who selected them in the counties that’ll now be empty.

Three other insurers will have plans in the three counties whereAnthem is staying, according to the state’s Department ofInsurance. They are Centene Corp., Aetna and UnitedHealth.

Korbulic, the Nevada exchange’s executive director, said she andother state officials are trying to convince the four companies toexpand into or come back to some of the empty counties. They haveuntil late September to make their final decisions.

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