Aetna CEO has serious concerns about Sustainability of Individual Markets

February 02, 2016

Aetna Inc.'s Chief Executive Officer Mark Bertolini said on a call Monday, "We continue to have serious concerns about the sustainability of the public exchanges." The insurance company's leader was discussing the company's fourth-quarter results. He went on to say, "We remain concerned about the overall stability of the risk pool."

Aetna is the third largest provider of healthcare behind Anthem (#2) and Unitedhealhcare (#1). UnitedHealth has said that it will probably take about $1 billion in losses on Obamacare plans when 2015 and 2016 results are combined. The company made a decision not be on the market in 2014 and recently stated that it should have stayed out of the market longer, and that it may quit the program in 2017.

In IL, the Co Op known as Land of Lincoln Health made a conscious decision to 'manage growth' and limited their enrollment this year. They worked with the IL Dept of Insurance and once they hit their enrollment numbers, they turned off the valve and are not accepting any new members. This 'shut off' happened at about noon on 12/30/15.

Blue Cross of IL has claimed to have huge losses in 2014 (millions of dollars), and claimed this is one of the reason for pulling their large PPO network from the individual marketplace. Being one of the largest carriers in IL with some of the most competitively priced plans, many people seeking coverage in 2014 (whether for the first time or coming from the state ICHIP pool of formerly deemed 'uninsureds') chose to enroll with Blue Cross. Meanwhile Land of Lincoln was late to come to the market in 2014 and did not sustain huge losses. However, several Co Ops across the country with big enrollments in 2014 have since folded and gone bankrupt.

One thing seems very clear, this law is not working - costs are not being contained if insurance companies are losing millions and billions and at the same time passing along 30-50% increases. This needs to be fixed if we are going to have any viable options in the future.