In other words, if the deal with Humana dies on the vine, so does all of Aetna’s public-exchange business.
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Bertolini says the company remains committed to “providing affordable, high-quality health care options to consumers”, but that it isn’t possible without a more balanced risk pool, meaning more young, healthy individuals to balance out those who may be older or sicker, and thus more expensive. Illinois Department of Insurance spokesman Michael Batkins says two insurers remain selling plans to small businesses.
That’s after both UnitedHealth Group and Humana announced their plans to stop offering plans through Obamacare in the state. And Chicago-based Land of Lincoln Health is folding after suffering heavy losses.
Aetna will continue to sell coverage off the exchange.
That’s true also for most urban exchange customers living in the Northwest, the Midwest and New England. That trend started several years ago, and some states have responded with regulations requiring insurers to provide customers with reasonable access to doctors and hospitals in each county where they sell plans. Citing financial losses, Aetna announced Monday that it’s scaling back its participation in Obamacare by more than two-thirds as it seeks to cut its financial losses.
Arizona had eight insurers operating in various parts of the state this year, but four are leaving entirely Aetna, UnitedHealthcare, Humana and Health Choice. The company said it took a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since 2014 in individual plans.
“In light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products”, Aetna CEO Mark Bertolini said in a statement, “we have made a decision to reduce our individual public exchange presence in 2017, which will limit our financial exposure”.
The department had asked Aetna how, if at all, a decision on the proposed merger would affect Aetna’s willingness to offer insurance through the exchanges. Specifically, the DOJ wanted information on the costs of the breakup fee, Aetna’s business strategy, and any other documents related to the Humana merger. “Fifty-five percent of our individual on-exchange membership is new in 2016, and in the second quarter we saw individuals in need of high-cost care represent an even larger share of our on-exchange population”.
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Off-exchange plans still have to meet the Essential Health Benefit requirements in ACA, such as mental health, substance abuse, emergency and prescription drug coverage. It is one of seven insurers who this year offered coverage in the department’s Region 6, which includes the Lehigh Valley.
