Aetna, the nation’s third-largest insurer, plans to leave almost 70 percent of the counties nationwide in which is now sells Affordable Care Act policies.
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A copy of that document shows the Justice Department asked for data on costs such as the breakup fee; the impact on Aetna’s business strategy, including participation on the Obamacare exchanges; and documents related to a June board meeting and the Humana deal or the exchanges.
Dwindling insurer participation is becoming a concern, especially for rural markets, in part because competition is supposed to help control insurance price hikes, and many carriers have already announced plans to seek increases of around 10 percent or more for 2017. In contrast, urban markets, where most people live, are expected to still have plenty of health insurance choices on their exchanges for 2017. But that may not be the case in many rural markets.
Health insurers have been finalizing their exchange plans over the past several weeks, ahead of the November 1 start of enrollment for 2017 coverage. Humana said it would dial back its participation on the exchanges from 15 states to 11 earlier this month.
Aetna spokesman TJ Crawford said in an emailed statement that since the company submitted the letter to the Justice Department, it had a better view of the business line’s second-quarter performance.
The cuts mean it will sell coverage on exchanges in 242 counties next year, down from 778. The Hartford, Connecticut-based insurer will sell on exchanges in Delaware, Iowa, Nebraska and Virginia next year.
Some insurers say they can only continue to provide care through the exchange if the federal government provides more money. 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.
Alabama, Alaska and Oklahoma are among the states that will have one health insurer selling individual coverage on their exchanges next year.
HHS said last week that the per-member health care costs for people covered through the exchanges remained stable from 2014-2015.
While the carrier as early as April continued to believe the exchanges were a good investment of resources, Monday found Bertolini singing a different tune, “Following a thorough business review and 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, we have chose to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward”.
Aetna regrets “having to make this decision” because it supports public exchanges to insure the uninsured, he said.
Government officials say the future of the exchanges remains strong.
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Another insurance company is leaving the federal Affordable Care Act marketplace in SC, further limiting choices for those who need coverage.
