Aetna pulling out of ACA

[timo2]

here is the letter people are using to say that Aetna is just playing politics

http://big.assets.huffingtonpost.com/AetnaDOJletter.pdf

from the NPR article: ere's the key paragraph (emphasis added):

"Our analysis to date makes clear that if the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses. Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint. We currently plan, as part of our strategy following the acquisition, to expand from 15 states in 2016 to 20 states in 2017. However, if we are in the midst of litigation over the Humana transaction, given the risks described above, we will not be able to expand to the five additional states. In addition, we would also withdraw from at least five additional states where generating a market return would take too long for us to justify, given the costs associated with a potential breakup of the transaction. In other words, instead of expanding to 20 states next year, we would reduce our presence to no more than 10 states. We also would not be in a position to provide assistance to failing cooperative exchanges as we did in Iowa recently."

Aetna Withdrawal From Obamacare Exchanges Seen In New Light : Shots - Health News : NPR

 

[timo2]

I think it is quite obvious that people buying on the exchange are not as healthy. A blind man could have seen that coming.

edit: And use more services surely. The same people who used to go to the emergency room when their child had a cold.

+1

 

[Fermion]

Seems perfectly reasonable. They wanted to merge with Humana to cut costs (only one CEO you have to pay $100million a year instead of two). Merger got turned down so they took their toys off the table and went home.

 

[ivinsfan]

here is the letter people are using to say that Aetna is just playing politics

http://big.assets.huffingtonpost.com/AetnaDOJletter.pdf

from the NPR article: ere's the key paragraph (emphasis added):

"Our analysis to date makes clear that if the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses. Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint. We currently plan, as part of our strategy following the acquisition, to expand from 15 states in 2016 to 20 states in 2017. However, if we are in the midst of litigation over the Humana transaction, given the risks described above, we will not be able to expand to the five additional states. In addition, we would also withdraw from at least five additional states where generating a market return would take too long for us to justify, given the costs associated with a potential breakup of the transaction. In other words, instead of expanding to 20 states next year, we would reduce our presence to no more than 10 states. We also would not be in a position to provide assistance to failing cooperative exchanges as we did in Iowa recently."

Aetna Withdrawal From Obamacare Exchanges Seen In New Light : Shots - Health News : NPR

Sounds like blackmail to me.....or I'll take my ball and go home. And we are stuck in the middle.

 

[523HRR]

A little free market competition would quickly figure out the most efficient pricing for health care and health care insurance.

 

[ShokWaveRider]

I think it is quite obvious that people buying on the exchange are not as healthy. A blind man could have seen that coming.

edit: And use more services surely. The same people who used to go to the emergency room when their child had a cold.

Sorry mate, but rubbish! I am healthy and use the exchange. Just because one has a minor pre-existing condition does not make them unhealthy.

 

[ShokWaveRider]

A little free market competition would quickly figure out the most efficient pricing for health care and health care insurance.

Nope, it would just allow the insurance companies to do selective insuring. "no Soup for you" "but you can have soup".

That is NOT a way to run a health care system for 300m people.

 

[Fermion]

Sorry mate, but rubbish! I am healthy and use the exchange. Just because one has a minor pre-existing condition does not make them unhealthy.

Yes, I am healthy too and also use the exchange. I also get a subsidized silver plan.

We are the minority I fear.

But I can see the flip side for people off exchange. I can see a few people gaming the system there, and buying a very high deductible policy with the knowledge that if they get a long term expensive illness, they will drop down into a silver or platinum plan because they can do that now.

Probably a minority there too.

I bet the exchange is mostly full of people who think a happy meal and coke is a well balanced diet. I may be totally wrong though.

 

[pb4uski]

Sounds like blackmail to me.....or I'll take my ball and go home. And we are stuck in the middle.

I think it is deeper than that... if the business was profitable or even if it was losing or minimally profitable but had future potential, they would stay in it... it seems to me unlikely that they would cut off their nose to spite their face. Now perhaps the timing of announcing and implementing the decision has something to do with the timing of the DoJ suit.

 

[explanade]

Since Humana is also reducing its ACA exchange footprint, maybe there's some kind of collusion there as well.

 

[FUEGO]

Since Humana is also reducing its ACA exchange footprint, maybe there's some kind of collusion there as well.

I'm curious about that as well. A little suspicious given the blocking of the merger and that letter.

 

[Ian S]

With Aetna leaving Arizona, Pinal County is apparently left with no plans whatsoever in the exchange. The Arizona Republic reports however, that BCBS of Arizona may rethink their own decision to leave Pinal County. Goodness, I'm so glad I went on Medicare this month!

 

[Fermion]

How in the world do they calculate subsidies if there are no plans on the exchange

Do you get to buy from the next county over or something?

 

[bUU]

I've said this a few times before on this forum: As a Marketing guy for over 30 years, I see the greatest failing of ACA is a complete lack of a simple, clear, concise explanation of what it is, how it works and what's involved.

That's inevitable when there are a number of people who are deciding those things, and those people very explicitly disagree with each other about those things, and even about more fundamental aspects of the situation. The most effective form of Work Avoidance is obstruction, followed by making the problem too large to solve and collecting more data before acting.

 

[Mulligan]

The thread title is misleading. Aetna is not pulling out of the ACA. In their own words "Aetna to Narrow Individual Public Exchange Participation". Here's their announcement News Releases - Investor Info | Aetna

They are not the lowest price players in the market exchanges where they participate, so their announcement will probably reduce competition but should have little impact on the subsidies.

They certainly were by far in my marketplace for my age the past few years. Aetna is also "Coventry" which is what I have. They are abandoning the exchange here, but keeping the non exchange plans here. I am optimistic they are thus keeping my plan for next year since I am off exchange.....And maybe not gig me as hard as expecting next year, since some of the loss leaders are being removed from the covered roster.
Aetna is very big in MO. They command a 38% marketplace share of the individual marketplace which is the largest insurer. However... They refuse to divulge any info on the percentage breakout between exchange and off exchange. Evidently enough that they do not want the losses on their books.


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[marko]

That's inevitable when there are a number of people who are deciding those things, and those people very explicitly disagree with each other about those things, and even about more fundamental aspects of the situation.

In the business world (where people's jobs are actually on the line) it's called "Product Ownership". The person in the trenches who owns this and is responsible for its success.

You put one person in charge at the detail level who calls the shots and who's career hangs on it; not a committee.

At roll out, AFAIK, there wasn't a single point person who was responsible for making this product succeed, no 'product readiness review', no effort to make the public aware of what it was, or what it wasn't.

Six years later most people still don't know what this is all about or how it works and sadly, through the lens of that lack of information people end up believing all sorts of things, as evidenced by this thread.

 

[explanade]

Can health insurance be simplified?

There are so many qualifications, in terms of which procedures and drugs are covered and which are not, which providers are included and which are not, etc.

When I was choosing policies at open enrollment every year with my employer, it wasn't much easier. This was with various comparison tools and so forth.

I think the confusion and complexity of choosing insurance are just a reflection of our expensive, balkanized health care system.

 

[Gotadimple]

However... They refuse to divulge any info on the percentage breakout between exchange and off exchange. Evidently enough that they do not want the losses on their books.


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Your state insurance commissioner should have that info, as they need to provide to them for rate approval on the off-exchange plans.

Rita

 

[Mulligan]

Your state insurance commissioner should have that info, as they need to provide to them for rate approval on the off-exchange plans.

Rita

I would assume the Stl Post Dispatch would have tried that route as they specially mentioned in yesterdays article it would not be released to them, but who knows as I certainly do not. We haven't had much "insurance oversight" here and have totally dumped it on the Feds. Our state until at least this year has had no input or regulatory control. I have read state may get more oversight, though.


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[bUU]

In the business world (where people's jobs are actually on the line) it's called "Product Ownership". The person in the trenches who owns this and is responsible for its success. You put one person in charge at the detail level who calls the shots and who's career hangs on it; not a committee.

Precisely. That'll never happen in government. Even when you privatize public services, it is still a committee - no... worse... a Congress - that the private company has to satisfy (which was precisely the case with ACA - my spouse worked for the product owner for one of the exchanges).

 

[brucethebroker]

"Try not to worry about things that may, or may not happen in the future". I have told my kids that for years.

Much of the distress about who the players will be, and how much it will cost is premature. The real info will not be known until later in the fall (open enrollment).

Meanwhile, it's back to another day in paradise (semi-retirement)............

 

[EastWest Gal]

There can be no market competition when the prices are kept secret. And when there is neither competition nor regulation of prices. With ACA, only part of the problem was partially solved. The other problem is combatting ridiculously high prices. Doctors and hospitals are regulated to death but they cheat anyway. My dad was billed for the highest level visit when the cardiologist spent 1 minute in the room and 10 seconds listening to his heart. My son was billed for critical care for a broken arm-yeah, I won that one. But he was also over billed for OR supplies. I couldn't fight that battle.

A patient is in no position to complain. One can get kicked out of the practice. Or worse.

We consumers need more robust representation.

The price of an Epipen just went from $100 to $400. This is a life saving emergency medication. It costs a few dollars to make. When asked why, the company gave gobbletygook for an answer.

We are caught in the middle of three very greedy systems, healthcare providers/hospitals, big insurance, and big Pharma. I'm one of them-a physician. In the lowest paid specialty.


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[travelover]

There can be no market competition when the prices are kept secret........

+1 Good post. Eventually the golden goose will be killed as a result of an angry backlash when the whole thing reaches a crisis point. Until then.........

 

[athena53]

Aetna is also "Coventry" which is what I have. <snip>
Aetna is very big in MO.

I had Coventry last year and then they sent me an e-mail during Open Enrollment telling me they were discontinuing the off-exchange policy I had for 2016 but here was a link to another policy I "might like". It had zero coverage out-of-network. Ummm, no. Just no. I realize they're required to cover out-of-network in emergencies but I don't want to fight after the fact about whether something was an emergency. I especially don't want to get hit with whatever some specialist charges when they close a surgical wound while I'm under anaesthetic- or when they're supplying the anaesthetic.

I went with BCBS. So far it's been a pretty bad move on Aetna/Coventry's part; I've had only routine preventative exams, which is typical for me.

 

[Mulligan]

I had Coventry last year and then they sent me an e-mail during Open Enrollment telling me they were discontinuing the off-exchange policy I had for 2016 but here was a link to another policy I "might like". It had zero coverage out-of-network. Ummm, no. Just no. I realize they're required to cover out-of-network in emergencies but I don't want to fight after the fact about whether something was an emergency. I especially don't want to get hit with whatever some specialist charges when they close a surgical wound while I'm under anaesthetic- or when they're supplying the anaesthetic.

I went with BCBS. So far it's been a pretty bad move on Aetna/Coventry's part; I've had only routine preventative exams, which is typical for me.

Yes, I had the same experience as you had. I don't even do the preventative exam waste of time though. But I do carry a sign around my neck in case of a medical emergency directing them to take me to 3 hospitals under in network. If unable to find them, let me die, as the bill would kill me anyways.


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