Now we know the real reason Aetna bailed on Obamacare

[milestogo]

On Monday night, news broke that one of the five largest insurers in the US, Aetna, was leaving 70% of the counties in which it offers insurance through Obamacare's public healthcare exchanges. The move was seen as a huge blow to the future of the Affordable Care Act, making Aetna the third large insurer, after United Healthcare and Humana, to significantly reduce its Obamacare business.

Aetna cited the large losses that the company has incurred from the exchange business — $200 million in the second quarter alone — when explaining its decision to roll back its business. These statements, however, appeared to be a dramatic turnaround from the company's first-quarter earnings call in April, when CEO Mark Bertolini said the firm planned to stay in the exchanges and that the company was "in a very good place to make this a sustainable program." Now, however, it appears a large reason for the shift in tone was the Department of Justice's lawsuit to block Aetna's merger with rival Humana.

A July letter, acquired by The Huffington Post, outlined Aetna's thinking on the public exchanges if the deal with Humana were blocked. The letter from Bertolini to the DOJ outlined the effect of a possible merger on its Obamacare business. For one thing, Bertolini notes that the cost savings from the Humana deal would allow the companies to further expand coverage into parts of the US. "As we add new territories, given the additional startup costs of each new territory, we will incur additional losses," the letter said. "Our ability to withstand these losses is dependent on our achieving anticipated synergies in the Humana acquisition."

Additionally, the letter seemed to foretell the move on Monday. Here's the key passage (emphasis added):

"Our analysis to date makes clear that if the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses. Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint.

"We currently plan, as part of our strategy following the acquisition, to expand from 15 states in 2016 to 20 states in 2017. However, if we are in the midst of litigation over the Humana transaction, given the risks described above, we will not be able to expand to the five additional states.

"In addition, we would also withdraw from at least five additional states where generating a market return would take too long for us to justify, given the costs associated with a potential breakup of the transaction. In other words, instead of expanding to 20 states next year, we would reduce our presence to no more than 10 states."

http://www.businessinsider.com/aetna-humana-merger-reason-for-leaving-obamacare-2016-8

This is for-profit health care.

[vlyons]

1. Time for the public option

Medicare for all! Who knows? Maybe all those folks getting abandoned by Aetna will vote for Clinton. Hope so.

[Hoyt]

2. More likely they'll blame it on Obama/Dems because they don't understand mess GOPer opposition

created when ACA was enacted.

[Amimnoch]

9. Well damn you!

Here I was feeling all great with Vlyons assessment of the public option and maybe people getting out the vote for Dems, and you come in with counter logic that also makes sense as a possibility....

Pissed all over my temporary happy thoughts.

You're probably totally right though. Never forget though, as awful as the republicans were and are.. it was Lieberman who pivoted the Senate away from the single payer. We were sooo damn close with the numbers to having it.

(btw the "damn you" is tongue in cheek, not intended as an actual insult)

[Hoyt]

16. Well, I'm hopeful a Public Option will be difficult to oppose now if the new Prez lays the

proper ground work.

[Amimnoch]

29. Me too. Very hopeful. Will depend mainly on the congress we get.

If we can sweep up in the house and Senate along with getting Clinton elected I absolutely believe we'll have a public option by the next mid terms. If not, the chances go down a lot.

[Hoyt]

30. The Public Option does one thing that Single Payer doesn't, let's the 40+% of folks adamantly

opposed to single payer. I think they are stupid. But if a public option works like we think, over time more and more people will gravitate toward it. I think going for broke with single payer will have too much opposition, even if the opposition is not the majority.

[Amimnoch]

34. I'm quite happy with either myself.

I've always thought government option, when it does finally get passed will likely just be a stepping stone to single payer.

Once the government option is there, I think companies that currently provide a healthcare benefit are going to start dropping those benefits like crazy. The government option is going to likely be the best option (being that it'll be the one that isn't profit driven), and start driving the health for money corporations out of business eventually turning into a de facto single payer.

It sickened me when it was either going to die in the Senate or get passed without the option. I hope Lieberman chokes on his insurance lobby kickbacks.

[awoke_in_2003]

32. Like the last time

our side will start the negotiations at public option, ensuring that they will not get it.

[Hoyt]

33. The last time, we were lucky to get what we got. But thanks for your opinion.

Start with single payer in negotiations and everyone will run. Like Sanders said, at best there were 8 Senators willing to support Single Payer.

[awoke_in_2003]

35. Starting the haggling

with what you want is the way to ensure you don't get it. It is a moot point, anyways. The insurance companies own enough politicians on both sides of the aisle to make sure nothing gets passed unless they approve it. And once the hubbub dies down, the fed will change their opinion and go ahead and let Aetna and Humana merge.

[nationalize the fed]

45. Too bad single payer advocates weren't allowed to speak at hearings

Surely you remember when Max Baucus (D-Insurance) had single payer advocates including Doctors and Nurses *****FUCKING ARRESTED***** at a HEARING?

Just think- if a Republican had done that there would have actually been protests.

Baucus's Raucous Caucus: Doctors, Nurses and Activists Arrested Again for Protesting Exclusion of Single-Payer Advocates at Senate Hearing on Healthcare

Democracy Now.org 2009

Advocates of single-payer universal healthcare — the system favored by most Americans — continue to protest their exclusion from discussions on healthcare reform. On Tuesday, five doctors, nurses and single-payer advocates were arrested at a Senate Finance Committee hearing, bringing the total number of arrests in less than a week to thirteen. We speak with two of those arrested: Single Payer Action founder Russell Mokhiber and Dr. Margaret Flowers of Physicians for a National Health Program. [includes rush transcript]...
http://www.democracynow.org/2009/5/13/baucus_raucus_caucus_doctors_nurses_and

Max Baucus is now the Ambassador to China. He doesn't even have to hear about it anymore. Nice Work Max! You showed em how it's really done!

[workinclasszero]

14. Damn right!

F these huge insurance companies!

They profit off of pain, suffering and the bankruptcy of millions!

[still_one]

28. Unless the makeup of Congress changes dramatically, it will be doubtful in the short term that will

happen, in regard to a public option or Medicare for all.

If we are able to win back the Senate, and the executive branch, that would help, but we really need both houses in Congress.

I would hope we could at least see solutions to address the deficiencies and holes in the ACA if nothing else

[gopiscrap]

42. Agreed I have been saying this for 30 years

[Thinkingabout]

3. This was not the explaination I heard on the morning news. Never expect the FOX

Listeners were to hear the truth, it is not to their advantage to know the truth.

[procon]

4. Sure sounds like extortion to me...

"Gimme this stuff or youse gonna be real sorry."

[Igel]

7. Or it could be

"if we merge, we'll have better resources to wait for the markets to become profitable, so we'd have one strategy. If we don't merge, though, we'd have a different strategy."

Notice that the letter's condition for not expanding hasn't been met.

[Moostache]

22. All that's missing is the stereotypical thumb-breaker in a bad leather jacket...

"That's a real nice healthcare law you got there...be a shame if something were to happen to it..."
(while menacingly pounding fist into open palm of other hand...)

Fuck these extortionists and pain profiteers.
That's what we need to start calling Healthcare Insurers...give them the respect they deserve, and just as "war-profiteer" remains a dirty word for all-time, so too should "Pain-profiteers" be held in similar low regard!

[TransitJohn]

5. It's for-profit insurance

Insurance does not equal care, and the conflation has set back progress time and time again.

[Plucketeer]

6. "We just need to fix Obamacare"

LOL..... Actually, it's "fixed" already. Has been since it's inception.

[SammyWinstonJack]

46. +1000000!

[LS_Editor]

8. Will beyond time health insurance companies are outlawed.

[Avalux]

10. Health Insurance companies have too much fucking power.

ACA tried to work with them and obviously, it's not working. I hope Hillary understands this and takes steps to end the stranglehold they have on patient's lives.

[ananda]

11. Single payer, please!

Or Public Option at the least!

We know where Sanders is on this.

Where is Senator Warren? has she
said anything?

[yallerdawg]

12. When 'denial of coverage' was your business model...

and now you have to pay to cover sick people when they need it, thanks to the ACA - and the government is watching like a hawk! - profitability gets a little more difficult!

Aetna decision exposes weaknesses in Obama’s health-care law

One solution would be to entice more people — particularly healthy ones — to sign up for insurance, whether through a more robust public outreach campaign or by warning them about escalating financial penalties for not having coverage. Another would be to find new and better ways to give insurers that cover the sickest people greater financial relief.

“Hillary Clinton has outlined concrete plans to make health coverage more affordable in and out of the marketplaces, with more choices, expanded relief for costs, aggressively containing prescription drug expenses and the choice of a public option,” he said.

Many of these initiatives, along with any move to stiffen the financial penalties for not purchasing insurance, would require congressional approval.

[global1]

18. So Aetna Has Resorted To Blackmail......

Why doesn't the government make the penalty for not having coverage equal or greater to what it would be if they had coverage. That way - it makes sense to buy into ACA and have the coverage rather than paying a penalty and not getting anything.

[yallerdawg]

19. You're right - the ACA wants to appeal to our sensibility.

The penalty for not carrying coverage gets higher and higher each year.

This "tax penalty" revenue kicks in to help offset the insurer's falling profit back to guaranteed level when healthy people don't pay in, too.

At some point, it makes more sense to get coverage rather than just give the money away! The incentive for the historically uninsured - in particular the healthy younger workers who opt out - who make the bet nothing happens to them - and bet the emergency room will take care of them anyway!

[Promethean]

20. Because desperate people do desperate things.

The plutocrats know they have milked people almost as hard as is possible. If the penalty were higher and enforced (its not) it would put a lot of people into a desperate situation. They are well aware of the downside of making so much money from weapons manufacture.

[highprincipleswork]

13. Mafia politics, economics, and healthcare.

[TygrBright]

15. Single (public) payer option ASAP. n/t

[Arugula Latte]

40. Hillary Clinton: "Single-payer healthcare will never, ever happen." We're screwed. nt

[George II]

17. It's a vindictive decision to get "even" with the Obama administration for blocking their merger.

[FighttheFuture]

21. The corporations are getting together to sabotage Obama Care when the R's could not. Now

the R's will have another weapon to attack Obama care with.

[Spitfire of ATJ]

23. It isn't about "Health Insurance"....

It's about Health Care.

You know.

Doctors?

Patients?

Any of this ring a bell it that boardroom you're so proud of?

Does it even sink in that you guys are parasites?

[geardaddy]

24. BCBS of Minnnesota just canceled all individual and family coverage beginning in 2017

Now I have to look for different coverage.

Fuck insurance companies and the lobbyists they rode in on.

[Uben]

25. Itwas just a good business decision

As you know, businesses need to make money. Big businesses need to make big money! The have CEOs to pay hundreds of millions, they have to buy advertising to tell you how much they care, they have to hire thousands of people to deny claims and lawyers to find reasons to do so. Its not cheap! If you don't want to get screwed by Aetna, then go get screwed by someone else.

Single-payer is the only answer. Take the insurance companies out of the equation. All they do is charge outrageous rates for being a middle man. Doctors don't have to be gazillionaires. Yes, they need to make enough to stay in business, but they don't need to have three houses, a yacht, and hand servants. I remember the days when doctors were middle-class and actually made house calls. Nowadays your lucky if they are even in their office on the day you have an appointment. You get seen by a physicians assistant, charged the same amount for a person that's not even a licensed doctor! Hospitals are a joke....they run every test they can on whatever machines they have to pay for, if you have good insurance. If not, you get a pill, and a swift kick out the door.

I go to a doctor once a year, usually. I'm lucky, I'm sinfully healthy at 61. I'm thinking of dropping my insurance, $7K/yr, and self-insuring. If I get cancer..., well, I'll just die. Gonna die anyway, why add a few more months of suffering to the equation? Do doctors do chemo? Hell no, they know its just legalized poisoning that may or may not extend your misery a little longer.

Dying is easy...its this damned life thing that's so difficult. The struggle continues.

[annabanana]

37. powerful post, Uben

We are living in a third world country whose infrastructure hasn't completely collapsed yet...

[uponit7771]

38. "I remember the days when doctors were middle-class and actually made house calls" WOW !!!

... I feel like a kid !!!

I don't even know what you're talking about !!!

Like whoa

[Uben]

39. When I was 4, there was a doctor that lived across the street from us.

They all made housecalls back then (late fifties early sixties). I would go to their house at night and he would read us kids stories. I still remember....Gulliver's Travels, Alice in Wonderland, etc. He had kids about my age. The good ole days!

[SomeGuyInEagan]

43. Well, those claims won't deny themselves.

Need bodies to to that. Or at least programmers to write the code and robosign the letters.

[Native]

26. The Guardian has a good article on this as well.

https://www.theguardian.com/commentisfree/2016/aug/17/obamacare-insurance-companies-want-to-weaken

[hueymahl]

27. The ACA has always been Rube Goldberg health coverage

I disagree with the statements on here that Aetna is "blackmailing" over the Humana issue. Their statement is a reasoned and expected statement from a for-profit insurance company that is solely interested in profit (like they all are, by definition). I do agree with the statements that when denial of coverage is your business model and that gets taken away, you are in trouble.

Private insurance companies like Aetna need to be sent to pasture. Single Payer Please.

[Hoyt]

31. Truthfully, a $300 Million loss is not that great if getting out means they lose their place as

a possible partner with government down the road. I doubt we will ever be rid of insurance companies. First, even with Medicare, insurance companies pay the claims, perform utilization and quality reviews, write coverage policies within government guidelines, enroll providers, answer questions, etc. Plus, insurance companies run Medicare Advantage plans which almost 33% of Medicare beneficiaries have voluntarily selected, and they run the Drug Coverage programs.

Fact is, government doesn't have the infrastructure to administer Medicare, and Medicaid in most states, and I don't see them ponying up the money to do so any time soon. It's actually cheaper, at least in the short-run, to let insurance companies do most of the direct administration. Might not be the way it should be, but it's the way it is. And some foreign countries have adopted a similar model.

[MrScorpio]

36. One step closer to Medicare for all

Private insurers are going to realize that they could have played ball and made some money.

They're not going to make any when they're left out in the cold.

[dubyadiprecession]

41. One less insurance provider in 11 states?

Have we been under the false impression that insurance companies somehow keep costs down? They are the unnecessary middlemen that profits before the doctors and hospitals profit.

[Divine Discontent]

44. As a former claims processor...

For profit health insurance sucks!! There's so much that pisses off people understandably when it comes to health INSURANCE... The bigger the claim, the more its micromanaged to f!!

[Amishman]

47. good! let the exchanges fail and we can get single payor

The existing healthcare spectrum is breaking apart, let it burn so we can get the unified national system we need

[lonestarnot]

48. Looks like single payer is coming.