The evolving health insurance marketplace is so tumultuous that a key ratings service has withdrawn a series of ratings for more than 125 health insurers, including HMOs and Blue Cross and Blue Shield plans across the country.

“The recession, the potential for health care reform and possible changes to reimbursement rates for Medicare Advantage products present an operating landscape the industry has not faced for many years,” A.M. Best said in its statement about the public ratings change for the insurers. “Competition, too, remains intense as insurers navigate a commercial market with limited growth prospects amid consolidation of both plan offerings and employer groups.”

A.M. Best assigned a category NR-5 (Not Formally Followed) to the financial strength ratings (FSR) and an “nr” to the issuer credit ratings (ICR) on these health insurers because “it is becoming more difficult to develop ratings based solely on public data,” it said.

The public data ratings for health insurers reflect a quantitative analysis of each company’s results based on publicly available financial information, but does not include any analysis based on interaction with insurance company management, non-public financial information or any affiliations that health insurers have with parents/affiliates.

The ratings service said health insurers “face an uncertain economic environment,” which it says could lead to declining enrollment and investment-related issues for the industry.

The ratings company expects the economy to affect commercial, medical and employee benefits writers because of decreasing group sizes and fewer new sales opportunities due to layoffs, consolidation or business closings.

Medicare Advantage will continue to contribute to enrollment growth, though reimbursement rates may be cut in 2009, effective for 2010, A.M. Best said.

Potential reform of the health care system, under consideration by Congress and President Barack Obama, could include changes to Medicaid, guaranteed issue requirements and national exchanges to enable universal coverage, though the price tag for any legislative proposal would likely be fiercely debated, according to the ratings service.

Margins were lower in 2008 compared with recent years, A.M. Best said, and health insurers may have to implement cost-savings initiatives to offset declining enrollment and to reduce administrative costs.

The ratings service said it expects stricter pricing discipline, particularly for non-public BCBS plans, as insurers focus on improving underwriting results, the continued impact of offsetting investment losses and lower investment income and maintaining profitability.

Companies for whom public data ratings were withdrawn include: ADVANTAGE Health Solutions, Alliance for Community Health, Aloha Care, AMERIGROUP Maryland, AMERIGROUP New Jersey, AMERIGROUP Ohio, AMERIGROUP Texas, AmeriHealth HMO, Athens Area Health Plan Select, Avera Health Plans, Blue Cross & Blue Shield of Rhode Island, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of North Carolina, BlueCross BlueShield of Tennessee, Bravo Health Mid-Atlantic, Bravo Health Pennsylvania, Care 1st Health Plan, CareFirst BlueChoice, CareFirst of Maryland, CareSource, CareSource Michigan, Children’s Mercy’s Family Health Partners, Chinese Community Health Plan, Colorado Access, Columbia United Providers, Community First Health Plans, Community Health Choice, Community Health Group, Community Health Plan of Washington, CommunityCare HMO, Cook Children’s Health Plan, Cox Health Systems HMO, DC Chartered Health Plan, Denver Health Medical Plan, Driscoll Children’s Health Plan, El Paso First Health Plans, Elderplan, Fallon Community Health Plan,  FirstCarolinaCare Insurance Company, Geisinger Health Plan, Good Health HMO, Grand Valley Health Plan, Group Health Cooperative, Group Health Cooperative of Eau Claire, Group Health Cooperative of South Central Wisconsin, Group Health Plan, Group Hospitalization and Medical Services, Gundersen Lutheran Health Plan, Hawaii Medical Service Association, and Health Alliance Plan of Michigan.

Also, Health Partners of Philadelphia, Health Plan of Michigan, Health Plus of Louisiana, Health Right, Health Tradition Health Plan, HealthNow New York, HealthPartners, HealthPlus of Michigan, HealthPlus Partners, HealthSpring of Alabama, HealthSpring of Tennessee, HMO Louisiana, HMO of Northeastern Pennsylvania, Horizon Healthcare Dental, Horizon Healthcare of New Jersey, Horizon Healthcare Services, Independence Blue Cross, Independent Health Association, Inland Empire Health Plan, Inter Valley Health Plan, Kaiser Foundation Health Plan of Colorado, Kaiser Foundation Health Plan of Georgia, Kaiser Foundation Health Plan of Ohio, Kaiser Foundation Health Plan of the Mid-Atlantic States,  Kaiser Foundation Health Plan of the Northwest, Kaiser Foundation Health Plan, Kern Health Systems, Kern Health Systems Group Health Plan, Keystone Health Plan East, Louisiana Health Service and Indemnity Co., Lovelace Health System, Managed Health, McLaren Health Plan, and MDwise.

Also, Medica Health Plans, Medical Associates Health Plan, Medical Health Insuring Corporation of Ohio, Midwest Health Plan, MMM Healthcare, Molina Healthcare of California, Molina Healthcare of Michigan, Molina Healthcare of New Mexico, Molina Healthcare of Utah, Molina Healthcare of Washington, Mount Carmel Health Plan, M-Plan, Neighborhood Health Plan of Rhode Island, Neighborhood Health Plan, New West Health Services, OPTIMA Health Plan, Paramount Advantage, Paramount Care, Paramount Care of Michigan, PARTNERS National Health Plans of North Carolina, Physicians Health Plan of Mid-Michigan, Physicians Health Plan of Mid-Michigan FamilyCare, Physicians Plus Insurance Corp., Preferred Plus of Kansas, PreferredOne Community Health Plan, PrimeCare Medical Network, PSO Health Services, Sanford Health Plan, Santa Clara County  SCAN Health Plan, Scripps Clinic Health Plan Services, Security Health Plan of Wisconsin, SelectHealth, Seton Health Plan,  Sharp Health Plan, Superior Dental Care, Tenet Choices, Texas Children’s Health Plan, Texas HealthSpring, The Health Plan of the Upper Ohio Valley, Total Health Care, Tufts Associated Health Maintenance Organization, UCare Minnesota, Upper Peninsula Health Plan, Vantage Health Plan, Virginia Premier Health Plan, Vista Health Plan, VIVA Health, WINhealth Partners and WPS Health Plan.