Aetna had filed paperwork in May to join Anthem, Harvard Pilgrim and Community Health in the ACA marketplace. The deadline for offering new plans in Arizona was this month.
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Many insurers past year had said they expected to profit on the exchanges, but now say more exchange rules must be changed for it to be sustainable.
Before the law’s main insurance provision took effect in 2014, many experts predicted that guaranteeing coverage to all consumers regardless of their pre-existing medical conditions would eventually create “sick” insurance risk pools that could not cover their costs without large premium increases each year.
“This will cause some disruption in the market, ” Custer added.
In April, Bertolini called the marketplace plans “a good investment” because it would have cost the company far more than $430 million to try to attract that many customers.
It is continuing in Iowa, Nebraska, Delaware and Virginia.
His progressive critics say he only has himself to blame, since he’s the one who made “a deal with the devil – the for-profit health care industry – to kill any meaningful public option in exchange for their support for industry-friendly health care reform and campaign cash”, according to Miles Mogulescu, in his 2010 Huffington Post, “Who’s Killing the Public Option?”.
“Providing affordable, high-quality health care options to consumers is not possible without a balanced risk pool”.
Bertolini said the high-risk population make-up of its customers “results in substantial upward pressure on premiums”. “It’s reasonable to expect similar attrition this year, ” he said Tuesday.
As of today, Aetna’s exit leaves all of SC and most of North Carolina with just one insurer next year, according to a Kaiser analysis.
Georgia’s enrollment total trailed that of Florida, Texas and North Carolina among states whose exchanges are federally run.
Meanwhile, many Republicans pounced on Aetna’s announcement as an opportunity to criticize the federal law. While Slavitt certainly doesn’t want to see so many insurers leave, he said this trend reflects a new market shake out.
“It seems increasingly apparent that the big, national insurers are having trouble making money and competing in the ACA marketplaces”, said Levitt.
“Aetna’s decision has a direct effect on competition in many parts of the country and it’s a bit of a red flag for the future”, said Larry Levitt with the Kaiser Family Foundation.
Bertolini said Aetna is encouraged that federal health officials will explore changes to the risk adjustment program.
Independence Blue Cross has dominated the exchanges in Southeastern Philadelphia, and it will likely pick up a bulk of the business from Aetna’s decision not to sell plans in 2017.
The news of Aetna’s pullback comes as it and Humana are seeking to merge.
Aetna has vowed to fight a government challenge to its proposed merger with Humana, but overall does not seem to be in bad financial shape.
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“Aetna’s decision to alter its marketplace participation does not change the fundamental fact that the Health Insurance Marketplace will continue to bring quality coverage to millions of Americans next year and every year after that”, Kevin Counihan, chief executive of the federal exchange operator HealthCare.gov, said in an emailed statement.
