- Aetna said Wednesday it will be completely exiting the Affordable Care Act (ACA) exchange markets next year by not participating in Delaware or Nebraska exchanges.
- The insurer said it is pulling out because of financial losses, adding that its individual commercial products lost nearly $700 million between 2014 and 2016 and could lose another $200 million this year.
- In first quarter financial results released earlier this month, Aetna reported a net loss of $381 million, largely because of fallout from its failed $37 billion merger attempt with Humana, and said it was pulling out of Virginia exchanges.
With uncertainties abound regarding the ACA and the stability of its exchanges, Aetna isn’t alone among big insurers deciding they are better off not participating. Anthem, Humana and UnitedHealthcare have also pulled out of several markets.
In a statement, Aetna said the combination of high numbers of new members and a larger share of members needing high-cost care "coupled with the current inadequate risk adjustment mechanism, results in substantial upward pressure on premiums and creates significant sustainability concerns."
Payers are especially concerned that there is no clear indication from the White House or Congress whether they will continue to receive cost-sharing reduction (CSR) payments that help insurance companies cover people with low incomes.
Some payers, however, are staying in and citing reports that the exchanges have been relatively stable. A recent survey from Oliver Wyman found that most surveyed payers say they are committed to the exchanges next year. Earlier this week, Blue Cross Blue Shield of Tennessee said it will offer plans in the Knoxville region, which otherwise wouldn’t have had any payers participating.
There is little reason to believe a decision on CSRs will be made soon. Although the House last week passed its ACA repeal bill, the Senate said it was in no rush to move on the legislation and Congress is currently busy reacting to the sudden firing of FBI Director James Comey.
Insurers have a late June deadline, however, for filing rates for 2018 as well as declaring their exchange market participation. States are concerned with some early rate fillings that have asked for substantial increases. Carefirst BlueCross BlueShield CEO Chet Burrell cited an expected loss of $100 million on exchange plans this year when asking for a 58% rate increase in some markets for 2018.