Aetna will complete its withdrawal from Affordable Care Act insurance exchanges for 2018, announcing on Wednesday that lingering financial losses and uncertainty about the marketplaces' future was prompting it to exit two final states.
According to an Aetna spokesman, the insurer will not sell individual health plans next year in Delaware or Nebraska. Its announcement came a week after the company said it would stop offering ACA health plans in Virginia in 2018 and a month after it said it would leave Iowa.
The cascade of state-by-state decisions represents a stark turnabout for the nation's third-largest insurer, which initially entered 15 states' marketplaces but last summer decided to slash its 2017 participation to just four. That retreat was the largest by any health insurer from the health-care law's marketplaces, which started in 2014 to provide coverage for people who cannot get affordable health benefits through their employers.
But insurers have discovered that their ACA health plans tend to attract too few of the young and healthy customers needed to offset the expense of covering older people with medical problems. Aetna and other insurers have repeatedly reported financial losses on that part of their business.
Many insurers, members of the Obama administration and ACA supporters portrayed jumps in premiums as one-time course corrections and predicted that both premiums and insurers' participation would level off. Three months ago, however, Aetna chief executive Mark Bertolini said the marketplaces were in a "death spiral" - an assertion at odds with recent analyses by the Congressional Budget Office.
Aetna lost $450 million last year on its nearly 1 million customers with individual health policies on and off the insurance exchanges. In disclosing the final departures Wednesday, spokesman T.J. Crawford said the company expects to lose an additional $200 million for 2017 on its remaining 255,000 ACA customers.
Along with "structural issues," Crawford said, "uncertainty that has surrounded the future of the exchanges for some time now . . . plays a significant role as well."
While affecting only two states, Aetna's announcement quickly set off political reverberations in the charged partisan climate over whether the sprawling 2010 law should be preserved or discarded.
Health and Human Services Secretary Tom Price seized on the insurer's decision Wednesday night as the latest ammunition to bash Obamacare, as the ACA also is known. The Trump administration and Republicans in Congress are eager to dismantle the law and supplant it with more conservative health-care policies, and Price said in a statement that Aetna's move "adds to the mountain of evidence that Obamacare has failed the American people. Repealing and replacing it with patient-centered solutions that stabilize the marketplace to bring down costs and increase choices is the only solution."
On the other hand, Sen. Thomas Carper, D-Del., issued a statement lambasting the president. "Instead of following through on his promise to ensure that all Americans would have better and less expensive health insurance, the Trump administration has done just the opposite by sabotaging the ACA insurance marketplaces in any possible way," Carper said. "This continued assault on the ACA's insurance marketplaces, just when they were becoming financially stable, has sowed confusion and fear among Americans about whether they will be able to access health care."
Carper said Aetna's withdrawal will leave a single insurer in Delaware's ACA marketplace and will force 12,000 state residents to find new coverage.
Aetna's statement said it has "at this time . . . completely exited the exchanges." However, a possibility exists that it could still offer some coverage in Nevada's marketplace under a Medicaid stipulation being negotiated in that state.
Meanwhile, the availability of ACA health plans in Nebraska is iffy. Aetna's planned departure means that no insurer has formally filed an intention to participate in the state's marketplaces for 2018. Insurers' deadline for filing 2018 rates there is mid-June, though. A spokesman for the only remaining insurer, Medica, told the Lincoln Journal Star on Wednesday that it still planned to participate.