August 16, 2016
1 min read

Aetna reduces Obamacare participation to four states

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Health insurer Aetna announced plans to cut its participation in Affordable Care Act public exchanges by nearly 70%, according to a press release.

Individual public exchange participation will decrease from 778 counties to 242 in only four states: Delaware, Iowa, Nebraska and Virginia, the company stated in the release. An off-exchange individual product option will be available in "the vast majority of counties" where public exchanges are being cut.

Mark T. Bertolini, chairman and CEO of Aetna, said that the company expresses "regret having to make this decision."

“Following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward,” he said in the release. “More than 40 payers of various sizes have similarly chosen to stop selling plans in one or more rating areas in the individual public exchanges over the 2015 and 2016 plan years, collectively exiting hundreds of rating areas in more than 30 states.”

With the lack of a balanced risk pool, an inefficient risk adjustment system, and pressure on premiums, there are "significant sustainability concerns," Bertolini said.

He also stated the company is "encouraged" by an HHS announcement regarding a potential modification of the risk adjustment program.

"We are committed to a health care marketplace that gives every American the opportunity to access affordable, high-quality care," Bertolini said in the release. "We will continue to evaluate our participation in individual public exchanges while gaining additional insight from the counties where we will maintain our presence, and may expand our footprint in the future should there be meaningful exchange-related policy improvements."

The company stated that these changes will not impact any 2016 coverage and that it will contact any affected members prior to 2017 enrollment.

Last month, the U.S. Department of Justice sued to block Aetna's acquisition of Humana as well as Anthem's acquisition of Cigna.