Aetna leaves ACA marketplace

AETNA withdraws from Affordable Care Act marketplace in 2018


Aetna, the nation’s third largest health insurance provider, announced it will no longer take part in the Affordable Care Act marketplace in 2018, for state-based individual insurance exchanges.


Aetna originally offered coverage in 15 states; in 2016 the company announced they would cut cut coverage in 11 states but coverage would maintain in Nebraska, Delaware, Iowa and Virginia.  This most recent announcement is that it would no longer sell individual coverage in those states next year. 


“Our individual commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership,” T.J. Crawford, an Aetna spokesperson to the Washington Examiner, “Those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration.”


Nearly 12 million people bought health coverage this year through healthcare exchange plans.


According to the Examiner, Aetna reduced its participation in 2017 after the Obama Administration's Department of Justice challenged the company's planned merger with Humana.


Aetna says that the decision “to leave the exchanges was based on $450 million in losses it suffered in 2015 on account of its exchange participation.”


Health insurers have been leaving the marketplace because they are afraid that the government will not provide cost sharing subsidies that reduce expenses like co-payments. Those are separate from tax credits that help pay premiums.  The White House has assured lawmakers it will pay the subsidies but have not offered long term guarantees.


The House of Representatives passed a health care bill to repeal and replace the Affordable Care Act but the Senate has not yet taken it up.