Major payer Aetna reported it was not going through with expansion plans and indicated it may leave all Affordable Care Act insurance exchanges, according to Bloomberg.
Here are five notes:
1. The payer was hit by higher costs than anticipated, leading the payer to closely evaluate its presence in 15 ACA state exchanges. This year alone, Aetna had losses surpassing $300 million.
2. Aetna CEO Mark Bertolini said the payer will make decisions regarding its ACA participation in the coming weeks.
3. Earlier this year, Aetna told investors it planned on breaking even on ACA plans and therefore had planned to offer coverage in five new states in 2017.
4. Despite the Aetna news, a HHS spokesperson said consumers will still have plenty of choices for ACA plans and said, "We have full confidence, backed by data, that the Health Insurance Marketplace will continue to thrive for years ahead as a place where insurers compete for business and consumers have access to a range of affordable coverage options," in an email to Bloomberg.
5. Mr. Bertolini criticized the ACA's risk-corridor program, with many arguing officials need to change the program. He said the program needs to have a non-zero sum pool rather than transferring funds from insurer to insurer.
More articles on coding & billing:
Humana brings Ameritox to court for false & fraudulent claims; seeks to recover millions: 5 key insights
Escalating drug prices will hurt Medicare's catastrophic prescription coverage: 5 things to know
The payer megamerger deals may soon unravel, leaving the ACA exchanges to suffer another blow: 5 points