Aetna Exiting Florida Obamacare Exchanges

TAMPA BAY, FL — Tampa Bay area residents who are insured by Aetna through Florida’s Affordable Health Care Act exchange will find themselves needing to look for a new carrier in 2017. The insurer has announced its intention pull out of most Obamacare exchanges across the country, including Florida, after suffering pretax losses of more than $430 million since January 2014.

The announcement was made by Aetna on Monday. Aetna joins such insurers as Humana, UnitedHealthcare and Blue Cross Blue Shield in scaling back participation in the federal government’s exchange programs.

“Providing affordable, high-quality health care options to consumers is not possible without a balanced risk pool,” Aetna CEO Mark T. Bertolini said in a Monday statement. Citing a second-quarter pretax loss of $200 million, Bertolini said Aetna regrets having to make the decision, but it cannot sustain the losses.

“Fifty-five percent of our individual on-exchange membership is new in 2016, and in the second quarter we saw individuals in need of high-cost care represent an even larger share of our on-exchange population,” he said. “This population dynamic, coupled with the current inadequate risk adjustment mechanism, results in substantial upward pressure on premiums and creates significant sustainability concerns.”

Aetna’s announcement does not impact coverage in 2016, the company said. Starting in 2017, however, it will only participate in 242 county public exchanges across the country. That number is down from 778. The states where Aetna plans to maintain an exchange presence are Delaware, Iowa, Nebraska and Virginia.

Aetna’s decision to pull out of most exchanges comes on the heels of the U.S. Justice Department’s decision to stop the company from buying its rival Humana, several media outlets have reported.

Kevin Counihan, CEO of the federal ACA marketplace, said in a statement that Aetna’s announcement won’t “change the fundamental fact that the Health Insurance Marketplace will continue to bring quality coverage to millions of Americans next year and every year after that.”

While Aetna has announced its exit from the program in most parts of the country, it did leave the door open for a return should changes be made to the ACA in the future that mitigate risks.

“We will continue to evaluate our participation in individual public exchanges while gaining additional insight from the counties where we will maintain our presence, and may expand our footprint in the future should there be meaningful exchange-related policy improvements,” Bertolini said.

According to the federal government, there were 12.7 million people enrolled in the marketplace as of February 2016.

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