Aetna, one of the five large public health insurers, said that it may totally pull out of the Affordable Care Act (ACA) exchanges because they do not know what the future of the law will be.
The ACA is better known as Obamacare.
Asked about the insurer’s future in the ACA’s individual insurance exchanges beyond 2017, CEO Mark Bertolini said on the company’s quarterly earnings call that the current move by Republican lawmakers to repeal the law has left the company will little choice but to stay away.
“We have no intention of being in the market for 2018,” said Bertolini. “Currently, where we stand, we’d have to have markets worked up … prices worked up for April 2017 to apply, and there is no possible way that we’ll be able to do that given the unclear nature [of where] that regulation is headed.”
Insurers must submit plans for their coverage offerings, including updated premiums prices, by April to participate in the 2018 plan year. With no cohesive replacement plan yet advanced by Republicans, Bertolini seems uninterested in pursuing the market.
Bertolini also expressed concerns about the current state of the ACA, saying “the intended goals of the ACA have not been achieved.” He also said that changes would need to be made for a replacement to be sustainable. From the call (emphasis added):
“As the public exchanges enter their fourth year, it is clear that in the absence of a significant shift in regulatory policy, the risk pools for the ACA-compliant individual commercial products will continue to deteriorate. However, we remain optimistic that the next wave of healthcare reform will focus on affordability, quality, and addressing the needs of the millions of Americans who remain uninsured or lack access to affordable healthcare. To that end, we continue to actively engage in constructive dialogue with law makers and regulators and are committed to working towards preserving the positive aspects of the ACA and developing consumer-based approaches that deliver access to affordable quality healthcare to all Americans.”
On the call Aetna executives said the company’s pre-tax operating loss on ACA exchange products was $450 million for the full-year 2016.
Bertolini later said Aetna may consider staying in some exchanges should they be profitable in 2018, but would re-evaluate for 2019 and 2020 based on the replacement plan advanced by lawmakers.
Aetna has threatened to leave the marketplace before. The insurer announced it would scale back their offerings on the public exchanges in August 2016. At the same time it was discovered that the company told the Department of Justice in a letter in July that if a proposed merger with rival Humana was blocked, the company would leave the ACA market entirely.
The merger with Humana was blocked by a federal judge on January 23. The judge, in his ruling, determined that Aetna’s drawdown in the ACA exchanges was a ploy to get the Humana deal through the anti-trust ruling and leverage their participation in the Obamacare markets against the DOJ.
Aetna has said it will review a possible appeal of the decision.
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