Aetna officials repudiate 'unfounded' accusations from senators

Mark Bertolini speaking

After a group of U.S. senators accused Aetna of leveraging its public exchange participation to push regulators to approve its deal with Humana, Aetna executives have fired back to defend the insurer's decisions.

Senators including Elizabeth Warren and Bernie Sanders said in a recent letter to Bertolini that Aetna’s decision to exit Affordable Care Act exchanges “appears to be an effort to pressure the Justice Department into approving” the Aetna-Humana merger, calling the move "dangerous and irresponsible."

But in a letter responding to the senators obtained by the Hartford Courant, Bertolini calls their claims "unfounded." It wasn't the DOJ's antitrust suit, but "market reality" that compelled the insurer to exit exchanges, he says. Connecticut Sens. Chris Murphy and Richard Blumenthal, the article notes, say they agree with Bertolini that there is “simply no basis” to believe Aetna acted in bad faith.

Administrative costs and an imbalanced risk pool motivated the decision to exit almost 70 percent of ACA exchanges, Aetna’s Chief Financial Officer Shawn Guertin added when speaking recently to analysts, according to the Courant. “All those holes in the system need to be plugged,” Guertin said.

Sanders and Warren had questioned why Aetna is withdrawing from states in which Bertolini had previously said the insurer's plans had a “very good cost structure."  

But market forces and the deterioration of Aetna's exchange business “is ultimately what drove us to announce the narrowing of our public exchange presence for the 2017 plan year,” an Aetna spokesman previously told FierceHealthPayer.

When it announced its move to pull back from most exchanges, Aetna said it has recorded pretax losses of more than $430 million since January 2014 for its individual products. For 2016 alone, the Courant says, Aetna expects a $300 million loss in that business segment.