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August 16, 2016
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Citing heavy losses tied to its low-cost insurance plans, one of the
larger health insurers in the United States -- Aetna Group -- has
announced that, beginning in 2017, it will no longer participate in the
Affordable Care Act (ACA) health care program also known as Obamacare in
11 of 15 states -- 242 of 778 counties nationwide. Aetna is the third
major insurer to announce similar pullbacks.
"The greatest concern for people living with HIV -- or people with any chronic health condition -- is that too many insurers will exit the market, making it harder to find a plan that includes someone's current provider while remaining affordable," said John Peller, president and CEO of AIDS Foundation of Chicago. "In Illinois, Aetna was one of the plans that offered access to HIV medications at relatively reasonable out-of-pocket costs. According to an analysis of plans we conducted with the Center for Health Law and Policy Innovation, many single-tablet regimen medications were $40 or $75 per month."
In total, the company reported pre-tax losses of $430 million in the first half of 2015 ($200 million in the second quarter). These losses reflected all individual health care plans -- including policies that do not fall under Obamacare exchanges. The policies will remain in effect through the end of the year, but enrollees must sign-up for a new health care plan for 2017.
An estimated 11 million people, of whom tens of thousands are living with HIV, have purchased health insurance through the Affordable Care Act exchanges to date. Following a similar path as other insurers -- including the leading U.S. health insurance provider, United Health Group -- Aetna blamed its losses on heavier than expected use of the health care plans by conditions requiring high-cost care. Successful insurance companies need healthy enrollees to help balance health plan members who are ill or have chronic conditions and use their policies frequently.
The insurance company may rejoin the exchanges in the second half of 2017, however.
In a press release, Aetna CEO Mark Bertolini said the company, "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."
He also said, "As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision."
William McColl, director of policy for AIDS United, says he believes that the health care marketplaces can succeed if they make efforts to take care of people with higher cost chronic diseases, including HIV.
"Aetna dropping out means that health insurance companies need to take a closer look at their business model and understand and accept some role as a public health provider," he explained.
"It also means that there is a need for Congress to come off the sidelines, stop obstructing the Affordable Care Act, find ways to cut costs for consumers, create lower risks for companies and make other needed ACA corrections that will make the marketplace useful for all."
Aetna's announcement came as the U.S. Justice Department continues its lawsuit to block the company from acquiring Humana, which the government says would violate anti-trust laws. Aetna maintains that the acquisition would lower costs and expand choices for consumers. The lawsuit was filed in July. Another proposed merger -- between Anthem and Cigna -- was also blocked by the Justice Department.
Diane Domina is a senior content producer at Remedy Health Media, LLC. She writes the Daily Dose for HealthCentral and is the editorial director at HealthCommunities. Her goal is to contribute to a valuable, trustworthy and informative experience for people who are searching for health information online.
Additional reporting was provided by JD Davids, managing editor of TheBody.com.
Copyright © 2016 Remedy Health Media, LLC. All rights reserved.
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