Senators press fight with Aetna over quitting ACA exchanges

Aetna CEO Mark Bertolini

Aetna CEO Mark Bertolini

Washington – A group of liberal senators and Aetna CEO Mark Bertolini continued their battle Friday, with the lawmakers accusing the insurance executive of avoiding their questions about Aetna’s decision to quit 11 health insurance exchanges.

“We are disappointed by your failure to respond in a meaningful way. Your lack of cooperation does not mollify our concern that Aetna appears to be attempting to force the Justice Department into approving its controversial merger by threatening access to coverage for millions of Americans,” wrote Sens. Elizabeth Warren, D-Mass., and Bernie Sanders, I-Vermont, and three other senators.

The senators had written Bertolini on Sept. 8, asking the Aetna chief about his decision to withdraw from 11 Affordable Care Act exchanges after the Justice Department challenged Aetna’s proposed merger with Humana. The senators asked Bertolini to respond to 12 questions, including “what exact costs Aetna will incur now that the Justice Department has challenged the merger” and how much it will cost the company if the merger is ultimately blocked.

They also asked Bertolini why his company agreed to pay Humana a $1 billion breakup fee if the merger were not approved and whether the company was aware this payment would endanger its participation in the ACA exchanges. Aetna, citing losses it had incurred on its exchange business, had said blocking the merger would increase its financial risk since the company would have to pay the breakup fee to Humana and would lose efficiencies the merger would provide.

Bertolini immediately wrote back to the senators, but Aetna would not release the letter, offering only a selected excerpt to reporters.

But on Friday, the senators released Bertolini’s letter.

It said the lawmakers made “several unfounded accusations about Aetna’s intentions,” and said the company’s decision to quit the insurance exchanges was based on “an overall, unsustainable imbalance in the individual market risk pool” on the exchanges that result in a less healthy group of customers and losses for insurers who participate in the exchanges.

“If unchecked, our losses would result in an unacceptable risk to the company as a whole, impeding our ability to deliver cost competitive health insurance to other lines of business, including Medicare and Medicaid,” Bertolini wrote.

Three other senators, all Democrats, also signed Friday’s letter to Bertolini, Edward Markey of Massachusetts, Sherrod Brown of Ohio, and Bill Nelson of Florida. But Connecticut’s Democratic senators, Richard Blumenthal and Chris Murphy, did not.

Blumenthal, however, said he hoped Aetna would respond to the senators’ questions.

“I hope Aetna will be as responsive to these questions as possible, and avoid even the appearance that it is seeking to influence well-merited legal action by the Justice Department,” Blumenthal said. “I have led the opposition to the merger and requested the Justice Department’s legal action to block it. I hope the company will explain more fully its reasons for withdrawing from the public exchanges. I have shared my concerns directly with the company.”

Murphy said Congress should not be “trying to find scapegoats.”

“As I’ve said before, while I’m disappointed Aetna decided to leave several health exchange marketplaces, there is simply no basis to believe they made this call in bad faith,” Murphy said. “Aetna has been clear that they may re-enter those exchanges they are exiting if conditions improve. ”

But his Senate colleagues say they do not believe Aetna is acting in good faith.

The senators said that, despite the serious legal risk that the proposed Aetna-Humana merger would not be approved, Aetna agreed to pay Humana $1 billion if the acquisition were not completed by the end of 2016.

“Our September 8th letter included a number of questions about the nature of Aetna’s ‘unrecoverable costs’ and asked why, despite the risks to shareholders and to insured customers, Aetna included them as a condition of the Humana merger deal.  Your response did not address a single one of those questions,” the senators wrote.

The senators’ letter again asked Aetna to respond to their questions about its pursuit of the merger with Humana and about its decisions related to participation in the federal exchanges.

This story was updated at 5:12 p.m. with the comment from Sen. Blumenthal.

Comments

comments