Aetna voices ‘serious concerns’ on ObamaCare sustainability

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Aetna’s chairman and CEO said Monday that the country’s third-largest health insurer had “serious concerns” about the sustainability of ObamaCare’s marketplaces. 

“We continue to have serious concerns about the sustainability of the public exchanges,” Mark Bertolini said on an earnings call Monday, according to prepared remarks. 

He said the company remained concerned about “the overall stability of the risk pool.”

{mosads}Many insurers, including Aetna, have been losing money on the ObamaCare marketplaces, also known as exchanges, in part because of a sicker and more costly mix of enrollees, known as the “risk pool.”

The country’s largest health insurer, United HealthCare, made waves in November when it said that its losses on the ObamaCare marketplaces might cause it to drop out of that market altogether in 2017. 

Aetna has been more optimistic. 

“We believe it’s incredibly important in the business we’re in that we insure all Americans,” Bertolini said earlier this month. “This is our first attempt to make this happen, and we believe we have an obligation to stick it out and work with it until we know that it won’t work, and I believe it is too early to give up on this process.”

An Aetna official told Bloomberg News on Monday that it has not become more pessimistic since those comments, and that it is still in a wait-and-see mode. 

In fact, Aetna said Monday it is “increasingly confident” it can improve its results from ObamaCare and the individual market in 2016. 

The ObamaCare marketplaces are also a small fraction of the company’s business. “This is not breaking the bank one way or the other,” Bertolini said this month. Overall, Aetna had $2.7 billion in profits in 2015, up from $2.4 billion in 2014. 

Still, insurers are seen as having set their premiums too low when the ObamaCare marketplaces began in 2014, and sicker-than-expected enrollees are forcing them to raise premiums in order to compensate. 

Bertolini said this month that the company had losses in the marketplaces of “mid-single digits” in 2015, but had priced to reverse that and get “mid-single digit” growth in 2016.

The Obama administration has pointed to a slightly higher percentage of young people signing up ahead of the preliminary enrollment deadline of Dec. 15 as evidence that the risk pool is improving. The final numbers, after the ultimate deadline passed on Sunday, are not yet known.

Aetna and other insurers have complained that “special enrollment periods,” which are sign-up opportunities for people in certain circumstances outside the normal window, are leaving them with sicker enrollees. 

The Obama administration earlier this month tightened up the rules some on these periods, but insurers said the changes were not enough. 

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