February 23, 2017

Aetna CEO Expects More Obamacare Pullbacks For 2018

16 February 2017, 07:48 | Winifred Adams

Humana, which covers about 150,000 people on exchanges in 11 states, announced Tuesday it's leaving the Affordable Care Act public insurance exchanges next year. Even Humana was already shrinking its market presence: it downsized from selling in 19 states in 2015 to 11 states past year.

Humana had already cut its participation in the exchanges to 11 states from 15; it quit altogether because it's "seeing further signs of an unbalanced risk pool" - meaning, again, that not enough young folks are paying in.

"Several major insurers have said they can not begin to decide whether to offer coverage next year until the government clarifies if and how it plans to change the rules", the Times reports.

Speaking at the Wall Street Journal's Future of Healthcare event, Bertolini said Humana's recently announced decision to leave the exchanges in 2018 is indicative of the troubled nature of the individual market.

Lawmakers have not yet coalesced around a plan to repeal and replace former President Obama's signature healthcare law, and insurers are warning they only have about a month before they start crunching numbers and setting premiums for 2018.

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But the company is a leading source of coverage in some regions, including Tennessee, which has one of the shakiest markets. The law was already facing an onslaught of negative publicity previous year as massive insurers like UnitedHealth (unh) retrenched from participating in its marketplaces and other firms spiked premiums thanks to enrollees' unexpectedly high medical costs. Two congressional Republicans, Kentucky senator Rand Paul and SC representative Mark Sanford, are expected to unveil an Obamacare replacement bill today that would lift restrictions on insurers and provide tax breaks to Americans who purchase healthcare.

Humana believes the Obamacare exchanges have too few healthy patients to balance out a significant number of sick and costly patients. According to him, Obamacare was a complete disaster and the President is hopeful that the rudiments of the upcoming plans will be in accordance by the end of 2017.

The health insurer made the announcement with its earnings update, following the mutual termination of its $34 billion merger agreement with Aetna (AET) earlier in the day. The nation's 5th largest health insurer now sells plans in the Knoxville, Nashville and Memphis markets.

The Trump administration sent a signal to insurers Wednesday, when it proposed a regulation aimed at "stabilizing" the marketplace that includes several changes insurers have long pushed for, such as shortening the enrollment period for 2018 and requiring proof that people signing up outside of the regular enrollment time qualify. Lower-than-expected medical costs helped offset some of those payments.

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