Aetna, one of America’s largest insurers, has made a decision to roll back much of its health-insurance plans offered through the Affordable Care Act (ACA), aka Obamacare. Health insurance analysts say three insurers are needed for a healthy competitive market. Those customers represent about 4 percent of the 216,000 residents covered through the exchange, according to the state insurance agency.
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Experts say it’s too soon to determine how shrinking insurer participation will affect rates beyond next year.
Aetna officials said the insurer will sell an “off-exchange” plan in Maricopa County next year, but such plans don’t come with financial subsidies that make marketplace plans appealing to eligible lower- and middle-income customers.
Almost half of the company’s total individual-plan losses since the exchanges launched in January 2014 came in the second quarter of 2016, largely as a result of higher-than-expected medical costs among enrollees and the inadequacy of a health-law program created to ease that risk, he said: “That’s not politics, that’s financial reality, which some choose to ignore”.
In a July 5 letter to the Justice Department, reviewed by The Wall Street Journal, Aetna said that if the Humana deal drew a legal challenge, “instead of expanding to 20 states next year, we would reduce our presence to no more than 10 states”. “I am shocked and disappointed that Aetna and its executives have chosen to abandon their Exchange members”, Goodwin said. Next year, some states, including Alaska and Oklahoma, will be left with only a single provider selling coverage to individuals. SC and most of North Carolina could join that list due to the Aetna decision, Cox noted.
Arizona Insurance Department spokesman Stephen Briggs said Tuesday that Blue Cross filings would allow it to offer Pinal County plans.
More than 12 million people nationwide get insurance from the marketplace.
At this point, her department said, it has no indication that any other insurers will be pulling out of the marketplace for 2017. Until that happens, insurers were expecting the federal government to help with the costs of caring for the early enrollees. Risk corridors were included in the ACA as a way for profitable insurers to assist unprofitable ones adjust to the new insurance market which now includes guaranteed acceptance and broader required treatment coverage. One month later, Aetna made a decision to pull out of insurance markets in 11 states. The company covers about 900,000 people through the exchanges.
In late May, the Kaiser Family Foundation estimated the number of rural counties at risk of having one insurer on the exchanges would triple in 2017. The pullouts by UnitedHealthcare and Aetna mean there will be only one carrier in the state in 2017 – Blue Cross and Blue Shield of SC. Humana has also said it plans to drop its presence from more than 1300 counties nationally, including some in Georgia, to around 150.
Federal ACA marketplace CEO Kevin Counihan responded to the cutbacks in a statement, saying, “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”.
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Even Aetna hasn’t given up on this business.
