Aetna becomes second insurer to pull out of Iowa's ACA exchange this week

Just days after Wellmark Blue Cross and Blue Shield said it would drop out of Iowa’s Affordable Care Act exchange market next year, Aetna has decided to follow suit—another worrying sign amid dwindling marketplace competition nationwide.

“Earlier today, we informed the appropriate federal and state regulators that Aetna will not participate in the Iowa individual public exchange for 2018, as a result of financial risk and an uncertain outlook for the marketplace,” spokesman T.J. Crawford wrote in an emailed statement.

He added that the company is still evaluating whether in 2018 it will continue its individual product presence in the remaining states where it sold exchange plans this year—Delaware, Nebraska and Virginia. Aetna had already drastically shrunk its marketplace footprint this year, a move that CEO Mark Bertolini has blamed on mounting financial losses.

Bertolini also previously cited young, healthy enrollees’ reluctance to enter the exchanges as one of the problems fueling insurer exits. That results in an older, sicker exchange population, and subsequently rising premiums, which he called a “fruitless chase” that leaves insurers with “a very bad pool of risk.”

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In his statement earlier this week, Wellmark Chairman and CEO John Forsyth indicated that the uncertainty surrounding potential solutions to stabilize the marketplaces was a major factor in the insurer’s decision to exit the Iowa market.

“While there are many potential solutions, the timing and relative impact of those solutions is currently unclear. This makes it difficult to establish plans for 2018,” he said.

The news out of Iowa comes in the wake of a recent report that large insurer Anthem might pull back considerably from the ACA marketplaces next year. Humana, a smaller player on the exchanges, already announced that will exit the individual markets entirely next year, while Cigna is still weighing its options.

In 32% of U.S. counties, individual market customers had just one insurer choice on the ACA exchanges in 2017, according to the Kaiser Family Foundation. In 2016, that was true in just 7% of counties.