ACA exchanges grow thinner with Aetna leaving for 2018

May 11, 2017 by Tom Murphy
In this Tuesday, Aug. 19, 2014, file photo, a pedestrian walks past a sign for Aetna Inc., at the company headquarters in Hartford, Conn. While Republicans rewrite the Affordable Care Act in Washington, the immediate future of the law has grown hazier with the nation's third-largest health insurer Aetna saying that it will completely divorce itself from state-based insurance exchanges. (AP Photo/Jessica Hill, File)

While Republicans rewrite the Affordable Care Act in Washington, the immediate future of the law has grown hazier with the nation's third-largest health insurer saying that it will completely divorce itself from state-based insurance exchanges.

Aetna said late Wednesday that it won't sell individual coverage in Nebraska and Delaware next year after projecting a $200 million loss this year. The insurer had already pulled out of several states after losing about $450 million in 2016.

The exchanges are a pillar of the federal law because they allow millions of people to buy coverage with help from income-based tax credits. But insurers like Humana, and now Aetna, have been fleeing that market, and the remaining coverage options are growing thin. Other companies like the Blue Cross-Blue Shield carrier Anthem say they are wary of returning without guarantees of at least one key financial support.

Every exchange had at least one insurer offering coverage for 2017, but a growing number were down to only one. Insurance experts expect holes to develop in 2018. Customers may be able to find individual insurance coverage off the exchanges, but those marketplaces offer the only way for people to get tax credits to help pay the premium.

Americans left with one carrier may see higher prices.

Metropolitan or highly populated markets are still expected to draw several insurers to their exchanges. But rural areas may not be attractive to insurers looking to cut losses. They generally have a smaller, older population and often a dominant care provider that makes it harder to negotiate rates.

About 12 million people bought coverage through the exchanges for this year. Most used tax credits to help buy coverage.

Among the states in trouble for next year is Iowa. Aetna is leaving that market, too. Wellmark Blue Cross and Blue Shield also said it will leave that state's individual market after only a year on it. Another insurer, Medica, said earlier this month that its "ability to stay in the Iowa insurance market in any capacity is in question at this point."

Earlier this year, Humana's decision to leave the exchanges temporarily left 16 Tennessee counties with no on-exchange coverage options for 2018. But BlueCross BlueShield of Tennessee recently said it would fill that void.

Insurers are in the middle of figuring out their prices and coverage plans for 2018. The departure of competitors from a market could play a role in their decisions because that may swamp those that remain with a wave of new customers, some of whom likely have expensive medical conditions. The ACA prevents insurers from rejecting patients based on their health.

"All it takes is one insurance company to exit, and that can create panic for other insurers and they pull out too," said Cynthia Cox, a health insurance expert for the nonprofit Kaiser Family Foundation, which studies health care. "Insurers don't want to be the last one holding the bag."

But she also noted that an insurer doesn't have to worry as much about pricing too high and losing business if it has no competitors in a market.

One big player on the exchanges, Centene Corp., has already said it expects to return to the exchanges next year.

Ultimately, though, insurers with the most common brand in health insurance, Blue Cross-Blue Shield, will decide the fate of the exchanges. Many of those plans specialize in individual insurance and have a long-standing presence in their markets. They also are the only remaining option on exchanges in nearly a third of the nation's 3,100 counties.

Anthem covers more than 1 million people on the exchanges. It said last month that it plans to return next year, but that could change if it doesn't know for certain by early June that the government will fund customer cost-sharing subsidies next year.

The subsidies are paid directly to insurers, and they help trim out-of-pocket costs like deductibles for customers with low incomes. Nearly 3 in 5 consumers on the exchanges qualify for this help, which totaled about $7 billion this year.

The White House has assured lawmakers it will continue making payments, but it has offered no long-term guarantee.

Customers are likely still several months away from knowing for certain final 2018 rates and participation.

Insurers have to make preliminary coverage plans by late spring or early summer, depending on the state, but they can then back out later this summer or seek additional rate increases, depending on how the business turns out.

Explore further: What if there's no affordable insurance to buy?

Related Stories

What if there's no affordable insurance to buy?

March 6, 2017
Leslie Kurtz needed three plates, eight screws and a big assist from her insurer after breaking every bone in her ankle while white water rafting.

Millions leaving government insurance money on the table?

October 4, 2016
Millions of Americans who bought individual health insurance outside the Affordable Care Act's public exchanges may be leaving money on the table if they skip those marketplaces again in picking 2017 coverage, a new report ...

Aetna, Humana call off $34 billion deal

February 14, 2017
Major health insurers Aetna and Humana called off their $34 billion combination after a federal judge, citing concerns about prices and benefits, rejected the deal.

Federal judge swats Aetna-Humana insurer combo

January 23, 2017
A federal judge has rejected health insurer Aetna's bid to buy rival Humana on grounds that the deal would hurt competition in hundreds of Medicare Advantage markets, ultimately affecting the price consumers pay for coverage.

Insurers may prove choosy with overhaul exchanges

January 17, 2013
UnitedHealth CEO Stephen Hemsley is warning analysts not to assume that the insurer will participate widely in a key health care overhaul coverage expansion that unfolds later this year.

Health care overhaul doubts ease for insurers

October 29, 2014
What a difference a year makes. The nation's biggest health insurers entered last fall cautious about a major coverage expansion initiated by the health care overhaul, the federal law that aims to cover millions of uninsured ...

Recommended for you

Insufficient sleep, even without extended wakefulness, leads to performance impairments

May 21, 2018
Millions of individuals obtain insufficient sleep on a daily basis, which can lead to impaired performance and other adverse physiological outcomes. To what extent these impairments are caused by the short sleep duration ...

New study shows higher formaldehyde risk in e-cigarettes than previously thought

May 21, 2018
Portland State University researchers who published an article three years ago in the New England Journal of Medicine about the presence of previously undiscovered forms of formaldehyde in e-cigarette vapor revisited their ...

Sleep better, parent better: Study shows link between maternal sleep and permissive parenting

May 21, 2018
Research has shown that consistently not getting enough sleep, or getting poor quality sleep, can put you at risk for a number of health conditions. But how does sleep, or the lack of it, affect how you parent?

Avoiding the car for travel could significantly lower risk of illness and death

May 21, 2018
People who are more active when commuting to work by walking or cycling could be cutting their relative risk of developing ischaemic heart disease or stroke by 11% and their relative risk of dying from these diseases by 30%, ...

Mediterranean diet may blunt air pollution's ill health effects

May 21, 2018
Eating a Mediterranean diet may protect people from some of the harm of long-term exposure to air pollution, and reduce their risk of dying from heart attacks, stroke and other causes of death, according to new research presented ...

Autism is not linked to eating fish in pregnacy

May 21, 2018
A major study examining the fish-eating habits of pregnant women has found that they are not linked to autism or autistic traits in their children.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.