Every county and locality in Virginia is now slated to have at least one insurer through the Affordable Care Act.

The  Anthem health insurance company announced Friday  that it would be filling every so-called “bare” county and locality in the state. Bare counties are those lacking a insurer through the Affordable Care Act exchanges.

Anthem’s decision means that Shenandoah, Frederick and Warren counties and the City of Winchester are all set to have one insurer covered through the exchanges. Warren County will be covered by Cigna, while Anthem is slated to cover the other areas.

But while Friday’s decision will leave all areas in Virginia with at least one insurer in the exchanges, premiums are set to increase under Anthem plans. According to a filing Anthem submitted to the Bureau of Insurance, premiums are set to increase between 42.5 and 62.1 percent.

Anthem’s  announcement follows a decision last week by Optima health insurance to scale back its planned expansion of  coverage to areas with Sentara hospitals. The action left 48 counties, including Shenandoah and Frederick, and 15 cities, including Winchester, without insurance options through the Affordable Care Act marketplace exchanges. (Optima is the insurance division of Sentara Healthcare.)

Then, on Sept. 12, Optima amended its filings, entering four bare counties, one partially bare county and one bare city, Ken Schrad, spokesperson for the State Corporation Commission, stated in an email.

Anthem’s announcement comes as a relief to state officials, who were worried that they would not be able to fill Virginia’s bare localities by the insurers’ Sept. 27 filing deadline. Although other states like Nevada and Ohio have had counties without any projected insurers and filled them later, Deputy Secretary of Health and Human Resources Joe Flores said last week with the Northern Virginia Daily that he did not think Virginia would be so lucky.

“We can’t ensure that these counties will have an insurer,” Flores said. “In fact, it’s probably unlikely that will happen.”

In a statement, Anthem said that Optima’s decision played a role in the changes.

“Since learning that 63 counties and cities would not have access to individual health plans, Anthem has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in Virginia,” the statement reads.

Secretary of Health and Human Resources Bill Hazel echoed Anthem’s sentiments, saying that he thought Anthem “felt some responsibility” for filling Virginia’s bare counties.

“[Anthem is] a big business in Virginia,” Hazel said. “They have had a good profitable business through the Commonwealth, and I think it is good citizenship of them to try to come back.”

According to Hazel, the Bureau of Insurance has asked all insurance providers in the state to adjust their rate filings to account for uncertainty surrounding the funding of cost-sharing reductions — subsidies that insurers are required to pay to a large number of Affordable Care Act enrollees in order to reduce the cost of insurance for those people.

Although insurers are required to pay the cost-sharing reductions, the Trump administration has threatened to cut off payments used to cover insurer costs.

“It’s inevitable that the plans will have to address that (uncertainty) in the rates,” Hazel said. “And that’s something that only Washington can fix.”

In its filing, Anthem cited the cost-sharing reduction payments as a significant factor in its decision to increase premiums.

Currently, the U.A. Senate Health, Education, Labor and Pensions Committee is mulling over measures designed to stabilize the Affordable Care Act marketplace. The proposals include guaranteeing funding for cost-sharing reductions for one or more years.

If Congress votes to guarantee the cost-sharing reduction payments, Hazel said that the Bureau of Insurance will once again require insurance companies to adjust their rates to account for the change.

But there is a narrowing window for Congress to enact those measures. Insurers currently have to submit their rates by Sept. 27.

Even if Congress extends that deadline, the open enrollment period starts Nov. 1, and state insurance regulators have to analyze the proposed rates before approving them.

“It’s not something that they can just turn around overnight,” Hazel said.