Aetna’s Bertolini: ACA has not met its goals

Aetna CEO Mark Bertolini

Washington – Aetna CEO Mark Bertolini said the Affordable Care Act has failed to meet its goals and the insurer isn’t likely to expand its participation in state exchanges in 2018.

“In spite of the best intention of Washington and industry, the intended goals of the Affordable Care Act have not been achieved,” Bertolini said in a conference call to investors Tuesday. “Millions of Americans remain uninsured and still lack access to affordable health care.”

Bertolini also said, “As the public exchanges enter their fourth year, it is clear that in the absence of a significant shift in regulatory policy, the risk pools will  continue to deteriorate.”

Aetna posted operating profits of $2.92 billion in 2016, but said it lost $450 million on its sales on the ACA’s exchanges.

Aetna is offering health plans on the ACA’s individual exchanges in four states this year, down from 15 a year ago. Bertolini said there was no way to expand participation in state exchanges next year.

“We’d have to have markets worked up, prices worked up for April ’17, in order to apply, and there is no possible way we’ll be prepared to do that, given the unclear nature of where regulation is headed,” he said.

Bertolini’s comments may bolster the arguments of President Trump and Republicans on Capitol Hill, who say the ACA is falling of its own weight.

Republican lawmakers are debating how to repeal and replace the ACA but have yet to come up with a plan. Bertolini said he is working with the Trump administration on a transition to a replacement for the ACA.

House Minority Whip Steny Hoyer, D-Md., disputed Bertolini’s comments and said they make defense of the ACA more difficult.

Hoyer said the Trump administration and Republicans are creating the uncertainty Bertolini says is hurting insurers.

“In other words, the chaos and uncertainty that this administration has created over the last 10 days has led to the very thing that they say is the problem – and that is insurers are not confident in the ACA,” Hoyer said.

Hoyer said there is no way the GOP can produce a plan Trump has promised to replace the ACA, with all Americans covered by health insurance “at lower costs.”

He said Democrats would not repeal the ACA, but are open to improving the health law.

A federal judge last week blocked a $37 billion merger between Aetna and Humana. Bertolini said he is disappointed with the decision, and that Aetna is considering an appeal.

“We have a merger agreement that goes to February 15th…and we’ll come to a conclusion before the 15th,” Bertolini said.

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