WASHINGTON – Insurance companies in several states report they may be forced to exit the government’s health care exchanges if President Donald Trump terminates federal payments used to reduce coverage costs to millions of low-income Americans.

They made their intentions known in filings with the government for larger rate increases than they would otherwise have sought if the cost-reduction subsidies were assured for next year rather than remaining up in the air.

Major insurers in Georgia and Kentucky were among those that said they could pull out if the federal payments stop.

Politico reported that Trump will meet with his aides soon to decide whether to continue the payments or end them, a move that would destabilize the exchanges and cause insurers to rush for the exit door as quickly as they are able.

Trump put the payments in question with a series of Twitter posts over the weekend, suggesting he might withhold them as leverage over Congress for failure to pass legislation repealing and replacing the Affordable Care Act, the vehicle for the subsidies.

The insurance industry has said without the subsidies, healthier people will drop insurance because the amount they have to pay out-of-pocket before benefits kick in would go up. That would increase costs for the less healthy who need insurance.

Blue Cross Blue Shield of Georgia said that even the 38 percent average increase it is seeking was “contingent” on the subsidies being paid through next year. Without them, the insurer said, it would be left with the choices of reducing the areas it serves, ask for higher increases or exit the exchanges altogether.

The insurers’ rate filings and concerns over losing their subsidies were made public Monday by the federal Centers for Medicaid and Medicare Services.

Anthem Health Plans of Kentucky also sought a 38 percent rate increase, but said it would have to re-evaluate continuing to sell subsidized insurance or seeking even higher rates should federal cost-sharing payments end.

Oklahoma’s lone Affordable Care Act insurer, Blue Cross Blue Shield, sought an 11 percent increase for its lower-cost Blue Advantage plan and a 2 percent increase in its higher-cost, larger network Preferred Plans.

It illustrated how the uncertainty is contributing, along with rising medical costs, to higher premiums next year. The company said it factored in the uncertainty over the subsidies and enforcement of Obamacare’s mandate that most Americans be insured into its proposed increase, according to an actuarial report attached to its filing.

The Texas insurer, CHRISTUS, said 15 percent of the 36 percent increase it is seeking is made up of covering additional costs if the government does not pay the subsidies or stops enforcing the requirement that individuals have insurance.

Meanwhile, Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, announced he’ll hold hearings in September to come up with a bipartisan bill to try to forestall sharp rate increases or insurers dropping out of selling subsidized insurance next year.

He said at a committee hearing Monday the discussions will be tightly focused on solving the health care system’s immediate crisis.

“There are many issues with the American health care system,” Alexander said. “But if you’re house is on fire, you want to put out the fire.”

Alexander said the goal is pass emergency legislation by Sept. 27, the drop dead date for insurers to sign contracts with the federal government to offer subsidized policies.

Cynthia Cox, a health policy expert with the Kaiser Family Foundation, said that’s likely too late to affect next year’s insurance rates. Companies have only until Aug. 16 to amend their rate proposals for next year.

Contact Washington reporter Kery Murakami at kmurakami@cnhi.com.