Despite recent critical remarks that diverged from his otherwise optimistic view of the Affordable Care Act marketplace, Aetna CEO Mark Bertolini says in an interview with Kaiser Health News that he does support the exchanges and wants to work with the Obama administration to improve them.
Bertolini (pictured right), who previously has said he believes the insurer has an obligation to "stick it out" in the ACA marketplace despite experiencing financial losses, took a slightly less sunny tone in an earnings call last month when he said "we continue to have serious concerns about the sustainability of the public exchanges."
That remark drew the attention of Secretary of Health and Human Services Sylvia Mathews Burwell, Bertolini tells KHN, who he said called him to ask why his position had changed. But Burwell "calmed down" once she read the full call transcript, Bertolini points out, given that his overall point was that Aetna supports the ACA exchanges but wants to see some changes.
Specifically, Bertolini wants the Obama administration to allow insurers more flexibility in benefit design in order to attract more young customers, who are needed to balance the risk pool. He argues insurers should be able to offer lower-deductible plans that allow consumers to focus on being healthy. But while some states, such as California, exempt initial doctor visits from annual deductibles, KHN points out that many states set standards for benefit design that don't allow for the variety Bertolini seeks.
Cigna CEO David Cordani made a similar argument in an interview in December, saying insurers want more flexibility to design products tailored to people who have so far avoided buying insurance. Already insurers have won one major battle, as the Centers for Medicare & Medicaid Services has announced changes to the rules that govern the ACA's special enrollment periods in response to their concerns.
High costs associated with the use of special enrollment periods is among the reasons UnitedHealth is considering exiting the ACA exchanges in 2017. Other major payers, including Blue Cross and Blue Shield insurers, also are struggling with losses in the individual market.
To learn more:
- read the KHN article
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