Aetna’s Obamacare Reversal Is Latest Blow to U.S. Health Law

[Purveyor]

Aetna Inc., facing more than $300 million in losses from Affordable Care Act health plans this year, may exit Obamacare markets in some states as challenges to the health-care overhaul pile up.

While the health insurer has yet to leave any states in which it now sells Obamacare programs, Chief Executive Officer Mark Bertolini said Aetna is evaluating its participation by market and will start making decisions in coming weeks. The company, which covers 838,000 people through Obamacare, is halting a planned expansion of those offerings in new states for next year.

“We’ve got to be able to cover the costs associated with providing the care,” Bertolini said in an interview.

Big insurers’ flight from Obamacare’s marketplaces, beginning with industry leader UnitedHealth Group Inc. earlier this year, will leave more consumers with fewer coverage options in 2017. The health law relies on privately run insurers to offer health plans that consumers can purchase, often with government subsidies. Last week, Humana Inc. announced a broad retreat from selling ACA plans, and Anthem Inc. said it would lose money from participation in the program.

MORE...

http://www.bloomberg.com/news/articles/2016-08-02/aetna-s-obamacare-reversal-is-latest-blow-to-u-s-health-law

[MrModerate]

1. If an insurance company can't make money in a subsidized market . . .

That hands them clients . . . then maybe we have more insurance companies than we need. Maybe insurance companies generally aren't as useful as they're made out to be . . .

[treestar]

6. Exactly

They are getting paid full amounts on subsidized people.

[former9thward]

14. They are paid premiums.

Not what they have to pay out in costs. Big difference.

[Igel]

13. It's not just subsidized, the benefits are often stipulated.

Many healthier people find the penalty less than the cost of health insurance, so those signing up tend to be less well, on average.

The subsidies themselves, the source of the payment for insurance, doesn't matter in the least. It doesn't matter if Calen Y pays for the insurance himself or the government pays 100%. The only reason the subsidies matter is that it allows the coverage pool to be skewed.

What did happen is that the predictions put out by supporters of the ACA were wrong. If they can't get something like that right, perhaps we have more financial analysts working for the government than we need. (Then again, the general rule is that the only predictions that those analysts got right in the last 7 years are those that weren't tested. If they said "unemployment will fall to X by such-and-such a year" or "this will create Z number of jobs", those were simply falsified. Neither political science nor law are considered STEM, so we can declares wishes to be fishes.)

Others did predict this.

[MrModerate]

16. I never said that profit-making insurance companies were a sustainable way . . .

Of administering the provision of healthcare. Clearly they're not.

Ultimately, to a nonexpert who's nevertheless been paying attention (that would be me), the ACA looks more like political will made real by way of a Rube Goldbergian law. A law that demands revision and that will be successively refined until we wake up on day and notice we've transitioned to a single-payer system and insurance companies are in their proper role of providing cover for "boutique extras."

Or so says my inner Pollyanna.

[Gary S]

21. The Republican controlled House of Representatives made sure the Affordable Care Act would fail...

The Republican controlled House of Representatives made sure the Affordable Care Act would fail by funding only 12.6% of the risk pool payments that were promised to the insurance companies under the Affordable Care Act.

Insurance companies built their plans and rates based on how the ACA was written. The ACA included risk caps. When some insurance companies lost large amounts, the federal government was supposed to help them. The Republican controlled congress funded only $362 million (or 12.6 percent) of the $2.87 billion requested by insurers in 2014.

Then, knowing that the Republican congress would betray them again in 2015, 2016, and 2017 it was inevitable that insurers would raise their rates, and that many would drop out. Why? Because they government was not funding the risk pool as the ACA had planned.

How important are risk pools? House Speaker Paul Ryan's plan as $25 BILLION dollars set aside over 10 years. Even HHS Secretary Price has $3 BILLION set aside for 3 years. Yet the Rebublican House only funded $362 million for 1 year (2014) under the Affordable Care Act?

The results of the Republicans' betrayal was totally predictable, and totally preventable. Shame on them for playing politics with the American healthcare system.

[leftstreet]

2. Nobody Could Have Predicted...

[Volaris]

5. Lol right???

The post below is also correct (regarding the profit of long-term business planning) but if they're too dumb plan beyond the short term losses they might incur, I'm not sure that's someone I want in charge of medicine delivery anyway. Fuck them let them run and when we're back to 30% uninsured again, we can push for universal single payer on the grounds that we tried the Republican alternative, and it was BAD for business and didn't work.

[tonyt53]

3. Yeah, but because the insurance is being utilized. In the next couple of years they will find gold

As people actually become healthier, their costs per insured will go down.

[csziggy]

11. The other problem is many young people are opting out

So the insurance is being used by mostly older and sicker people. If there was a national health plan and everyone paid in, the cost per person would be lower.

[TransitJohn]

4. Public Option coming?

One can hope.

[Volaris]

7. Fingers crossed.

Don't medicare prescriptions get bulk-buy pricing discounts, or somesuch? That by itself would bring in enough peeps to make that system viable.

How is again that it's tyranny if I SIGN UP FOR IT???

[jman0war]

8. Public Option first, then Single Payer

I'd like to see some strategists start plugging the holes in ACA with a Public Option.
With a view toward Single Payer eventually.

But so far when some health insurer withdraws from ACA, i'm not hearing about the need or any proposal for a Public Option.
These stories are opportunities.

[kacekwl]

9. I browsed the story and can't find

the info I was looking for. Is the 300 million a loss of profit (or projected/forcasted profit) or an actual 300 million loss of hard cash. A big difference in losing profit , losing cash or losing what the profit would have been if they were allowed to screw folks like the used to .

[RobinA]

17. Also,

Is Aetna losing money, or is one tiny subset of Aetna losing money? Have they managed to make other customers make up the difference and therefore are just bitching because they can?

[RobinA]

18. OK

“Aetna achieved record annual operating revenue and operating earnings in 2015, and delivered full-year operating EPS that was above our most recent projection,” said Mark T. Bertolini, Aetna chairman and CEO.

Cry me a river.

[kacekwl]

19. Loseing 300 million makes

a great headline over at Fox .

[frazzled]

10. But Cigna has just announced it will enter the ACA market in the Chicago area

One of the nation's largest health insurance companies plans to enter the Obamacare marketplace in the Chicago area for the first time, bringing new competition as other insurers exit or go out of business.

The Tribune has confirmed that Cigna, based in Bloomfield, Conn., has filed plans to sell health policies to individuals and families who purchase their own coverage in the individual market. If the plans are approved by Illinois regulators, Cigna will start selling policies Nov. 1, when enrollment for 2017 Obamacare coverage opens.

Cigna spokesman Joe Mondy said the company is focusing on the Chicago area and not the entire state. He said it was premature to provide details about proposed provider networks, benefits and the cost of insurance until the company's rate filings are approved and the health plans are ready for sale.

http://www.chicagotribune.com/business/ct-cigna-aetna-obamacare-illinois-0727-biz-20160726-story.html

We have had Cigna HMO plan through my husband's employer for some years, and have been more than happy--no, I'll say ecstatic--about it. After decades of minimal health care needs, we hit the big time last year when my husband was suddenly diagnosed with advanced-stage lymphoma. Several lengthy hospital stays, several kinds of surgical biopsies and port implant, repeated expensive PET scans and dye CT scans, 5 months of chemo treatments, and in the end, a major surgery with a hospital stay. Cigna paid for every cent of it (minus copays for office visits with his oncologist), everything approved.

I don't know if an ACA plan through this company will be the same, but if you live in the Chicago area and need to change your ACA plan, I'd give it a good look. But pick the HMO rather than the PPO if you can; it provides better coverage for less cost, and will give you access to every specialist and surgeon connected with Northwestern Memorial Hospital (or at least it did for us: these individual plans may have different network availabilities). You will just need an initial referral from your primary care provider.

Perhaps Cigna has decided to enter in this area, as opposed to the rest of the state, because of the comprehensive network of doctors and hospitals available in this large city. Plus the numbers of people.

[mountain grammy]

12. Public option! Let's do it.

[Freddie]

15. Seems like Blue Cross is doing well with Exchange plans

My employer had Blue Cross so they knew when my son turned 26 and would get kicked off my work plan. Somebody from BC called me every day for weeks asking what he was going to do for insurance. My employer switched to Aetna on 7/1 and I put my son on COBRA. Sorry BC.

[WillowTree]

20. Depends on which Blue Cross you're talking about.