Aetna CEO: Insurer won’t return to exchanges until ACA fixes are in place

Mark Bertolini speaking

Aetna won’t return to the public exchange markets it has left for at least another two years, according to the company’s CEO, and only if legislators are willing to make improvements to the Affordable Care Act.

In August, Aetna announced it was significantly paring down its exchange offerings in 2017, citing overwhelming financial losses within the market over the first three years. Aetna CEO Mark Bertolini told attendees at Bloomberg’s The Year Ahead Summit that the insurer wasn’t ruling out a return to the ACA marketplaces, but that it was waiting for legislative changes that would offer insurers more support for covering a sicker patient population.

Given the divisiveness within Congress over the ACA, and the slow process of implementing new regulations, Bertolini said re-entering the exchanges wasn’t likely until “2019, maybe 2020.” House Republicans have recently shown a willingness to discuss smaller-scale changes to the law, a shift from the GOPs push to replace it altogether. Experts have said there are opportunities for bipartisan improvements, regardless of the outcome of November’s presidential election.

Innovation Awards

Submit your nominations for the FierceHealthcare Innovation Awards

The FierceHealthcare Innovation Awards showcases outstanding innovation that is driving improvements and transforming the industry. Our expert panel of judges will determine which companies demonstrate innovative solutions that have the greatest potential to save money, engage patients, or revolutionize the industry. Deadline for submissions is this Friday, October 18th.

Bertolini's comments offered a distinct departure from his perspective earlier this year, when he said “it’s not time to give up” on the exchanges. But this week he told conference attendees that healthy, young people prioritize “gas for the car” and “beer on Fridays and Saturdays” over health insurance, a problem that is only exacerbated by double-digit premium increases. Recruiting young people has been a priority for the Obama administration's final open enrollment period.

“What happens is the population gets sicker and sicker and sicker and sicker,” Bertolini said, according to Bloomberg. “The rates keep rising to try and catch it. It’s a fruitless chase, and ultimately you end up with a very bad pool of risk.”

A primary sticking point for insurers has been the overwhelming number of sicker, costlier patients who sought insurance through the exchanges, although some argue that should have come as no surprise. Dwindling competition has been a concern in the lead up to 2017’s open enrollment period after major insurers exited a number of counties, but government officials have said those concerns are overblown.

Suggested Articles

As the public debate on health reform rolls on, a new report analyzes how these different approaches could impact insurers' bottom lines.

A House panel is going to consider several changes to Nancy Pelosi's drug prices plan, including stiff penalties for not being transparent.

Molina aims to bolster its Medicaid business by acquiring certain assets from New York-based YourCare for $40 million.