Aetna pulling out of ACA

[pb4uski]

It seems to me that if the exchange business provided adequate returns that Aetna would stay in it irrespective of its DoJ issue... but if the returns are inadequate then it needs to withdraw and deploy capital in more profitable endeavors... that's just smart business.

[marko]

Quote:

Originally Posted by nuke_diver Educate me a bit here. If a HC pulls out of ACA does that mean they won't offer any insurance at all or not through the exchange only? Are they still bound by the same requirements (ie no refusal for preexisting conditions) or can they dispense with that inconvenience (on their part)?

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.

At roll-out, I had been hoping for some set of PSA's on TV, a home mailer to every person in the country and maybe even a half hour "must see TV" special on this change.

Crickets! As my boss would say "Amateur Hour".

Six years later, even on this forum of above average savvy consumers, there is a ton of misinformation and myth.

Sad.

[Sojourner]

So if Aetna is pulling out of the ACA market in various states, yet continuing to offer similar (or identical) plans in the private market in those states, I would assume this means they are making significantly more profit in the private market. Is that a fair assumption? And if so, why is that? Could it be because people who buy plans through the exchanges are, on average, not as healthy and more likely to exceed their deductibles? Or maybe, since people choosing ACA plans tend to qualify for cost sharing subsidies, they are more likely to use health care services "frivolously", thus eating into Aetna's profit margins? Or maybe a combination of these or other factors? And if these are the reasons, wouldn't this ultimately affect every insurance company offering plans through the exchanges?

[Fermion]

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.

[explanade]

Well the people buying on the exchanges can also buy off the exchanges.

Only advantage in buying on the exchanges is eligibility for subsidies?

Oh and it's one web site to view plans from several different insurers.

[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]

Quote:

Originally Posted by Fermion 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]

Quote:

Originally Posted by 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

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]

Quote:

Originally Posted by Fermion 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]

Quote:

Originally Posted by 523HRR 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]

Quote:

Originally Posted by ShokWaveRider 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]

Quote:

Originally Posted by ivinsfan 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]

Quote:

Originally Posted by explanade 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]

Quote:

Originally Posted by marko 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]

Quote:

Originally Posted by MichaelB 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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