Aetna reverses exchange expansion plans, sells Medicare Advantage assets

Aetna won’t be expanding its offerings on the Affordable Care Act’s marketplaces after its second quarter earnings report projected it would lose more than $300 million on its exchange business.

The announcement by Aetna CEO Mark Bertolini comes only weeks after the federal government filed an antitrust lawsuit against the insurer, seeking to block its proposed merger with Humana.

“While we are pleased with our overall results, in light of updated 2016 projections for our individual products and the significant structural challenges facing the public exchanges, we intend to withdraw all of our 2017 public exchange expansion plans, and are undertaking a complete evaluation of future participation in our current 15-state footprint,” Bertolini said.

Humana announced it was exiting “substantially all” ACA exchanges after the lawsuit was filed, but it had threatened to depart months before the U.S. Department of Justice (DOJ) took any action against the proposed merger. Aetna, however, had been hinting it would offer exchange plans in new states for 2017. Bertolini’s latest comments are noticeably different from what he said in April, when he called the exchanges “a good investment.”

Overall, the company increased its year-to-year income in the second quarter, increasing from $731.8 million in the same period in 2015 to $790.2 million this year.

In a separate announcement, Aetna and Humana sought to alleviate concerns about the DOJ lawsuit by selling $117 million in Medicare Advantage (MA) assets to Molina Healthcare. Molina would gain about 290,000 MA members in 21 states. Aetna alone has more than 1.3 million MA members, according to its earnings report, but Bertolini told investors it plans to push back on the DOJ’s argument that the Humana acquisition would limit completion in MA markets.

“The DOJ action ignores the simple fact that there is robust competition in Medicare as evidenced by all Medicare eligibles are free to choose between traditional fee-for-service and Medicare Advantage," Bertolini said.

The DOJ was asked when the lawsuit was announced if Aetna or Humana could use divestitures to satisfy antitrust concerns. Bill Baer, assistant attorney general for the department’s antitrust division, responded by saying it had “zero confidence” that the sales of assets being proposed would meet its standards on maintaining a competitive market.