Aetna completely out of ACA exchanges for 2018

Making good on promises made by its CEO earlier this year, Aetna confirmed it will not offer policies on the Affordable Care Act (ACA) exchanges in any market for 2018.

The insurer had already announced exits from Virginia and Iowa. Aetna spokesperson T.J. Crawford confirmed via Twitter on May 10 the company wouldn’t be offering plans in Nebraska or Delaware on the on- or off-exchange individual markets, which completes its exits from the exchanges.

A follow-up tweet from Crawford said the company took heavy losses on its 2016 individual market plans, losing $450 million serving 964,000 members. Despite reducing its participation for 2017, its projecting another loss of around $200 million.

The exit is far from a surprise. Aetna CEO Mark Bertolini said in January it had “no intention” of participating in 2018. He later claimed the markets were in a “death spiral,” an assertion disputed by health policy researchers at the Brookings Institution.

The motivation behind Aetna’s reduced participation was questioned in the antitrust ruling blocking its proposed merger with Humana. According to the ruling by U.S. District Court Judge John Bates, Aetna pulled out of markets for 2017 to “improve its position” in the lawsuit, not for business reasons, seeking leverage against the U.S. Department of Justice (DOJ).

“Bertolini believed that DOJ should not block the merger in view of Aetna’s role in advancing the ACA and participating in the exchanges, and Aetna was willing to offer to expand its participation in the exchanges if DOJ did not block the merger, or conversely, was willing to threaten to limit its participation in the exchanges if DOJ did,” Bates wrote.

Aetna’s exit follows Humana’s full departure from the exchanges, which was announced just hours after Bates ruled against their merger.

With the insurer’s departure, Medica is left as the last exchange insurer for Nebraska and Highmark Blue Cross Blue Shield as the final option for Delaware customers. A recent study by the Urban Institute found exchange shoppers on single-insurer exchanges are likely to pay higher premiums.