Aetna says its plan to decrease its Affordable Care Act exchange participation is due to continuing financial losses-but a recently surfaced document also ties the decision to the lawsuit against its deal with Humana.
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Democrats continued to defend the law, but Hillary Clinton’s campaign said Aetna’s decision to withdraw from 11 of the 15 state exchanges it participated in could open the door for a plan backed by Clinton – including in the exchanges a “public option”, or government-run plan to compete with those offered by private insurers. Lobley said IBC remained committed to its members and to health-care reform.
The Hartford-based health insurer said it will reduce its participation in health care exchanges next year to 242 counties from 778.
“We see these decisions as an opportunity for CareSource to offer a safety net of quality health care coverage options for the thousands of consumers impacted”, said Steve Ringel, president of the OH market for CareSource. The availability and cost of insurance plans varies by county and by state.
The announcement follows UnitedHealthcare’s departure from the IL exchange. Levitt said people in about a quarter of all counties will only have one option.
“Everybody launched into this new market without a lot of data, made their own assumptions and now they are spending time adjusting to those assumptions”, he said.
The company now participates in health care marketplace exchanges in 15 states. SC and most of North Carolina could join that list due to the Aetna decision, Cox noted. It will continue to offer individual plans off the exchange, he said. Those who’ve signed up for coverage are sicker and costlier than expected, while too many healthier Americans are opting to pay a penalty rather than a premium.
Aetna, which covers more than 800,000 people with individual marketplace plans, cited higher-than-expected medical costs as the reason for its exodus after posting a pre-tax loss in the second-quarter of $200 million from its marketplace business. Insurers have struggled to enroll enough healthy people to balance the claims they pay from high-cost customers, and they have complained about steep shortfalls in support from government programs created to help them.
Next year will be Obamacare’s fourth of providing coverage in the new markets.
In some states, Aetnas decision to leave Obamacare will result in a significant loss of competition among health insurance providers. It will only sell Obamacare policies in Delaware, Iowa, Nebraska and Virginia. “UnitedHealth Group Inc. and Humana Inc., which Aetna has agreed to buy for $37 billion, are also pulling out after posting hundreds of millions of dollars of losses”. “But I don’t think the marketplaces are crashing and burning by any means”, she said.
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Even Aetna hasn’t given up on this business.
