Aetna Announces Their Withdrawal From Health Insurance Exchanges

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Health Insurance Exchanges

In a recent announcement, Aetna confirmed that they are withdrawing their participation from Affordable Care Act’s HIEs. Aetna is planning to withdraw their participation in 11 states, including Texas, South Carolina, Pennsylvania, Ohio, North Carolina, Missouri, Kentucky, Illinois, Georgia, Florida, and Arizona, as the provider suffered major financial losses due to high-risk patients in the regions.

Several other insurers, such as UnitedHealth, Humana, and Oscar, have also recently pulled out their participation from ACA’s Health Insurance Exchanges. However, this decision from Aetna, totally contradicts what their leaders mentioned a few months ago.

Earlier in June, CEO Mark Bertolini had said that Aetna’s participation in Health Insurance Exchanges was a “sound business decision”. He further added that they are planning to extend the participation in the upcoming years.

Another significant thing to note about Aetna’s withdrawal is that the announcement came just a few weeks after the proposed merger between Humana and Aetna was challenged by the Department of Justice. Consequently, the timing of Aetna’s withdrawal from Health Insurance Exchanges has raised numerous questions about the reasons behind such a decision.

Even though reports have clarified that Aetna is suffering huge losses in the HIE market, many experts doubt that Aetna opted out of the participation as a sign of retaliation for challenging their proposed merger with Humana. Furthermore, this speculation was highly strengthened when a letter from Aetna to the Department of Justice was uncovered that stated, “If the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 Exchange footprint.”

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Affordable Care Act

However, Aetna representatives said in a conference that the financial losses suffered by the company in HIEs and their failure to strengthen themselves through purchasing Humana has made it tough for them to continue participating in ACA’s Health Insurance Exchanges.

This shocking announcement from Aetna will affect more than 8000 individuals, who are currently under the Aetna Health Plan purchased through ACA Health Insurance Exchange. The withdrawal of major companies has created a great concern among American citizens, as approximately 1.5 million individuals out of the total 11 million individuals will now have to search for new coverage for the next year.

This will also leave many ACA marketplaces with only a single participating insurer, where there would be no ACA approved health plans at all in the Arizona country. A recent study from Avalere Health indicates that approximately half of the ACA marketplace regions will have only two or less than two insurers selling plans in the next year.