Posted by on February 15, 2017 10:35 pm
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Categories: 111th United States Congress Aetna death spiral Economy Excises Fail Finance Health Health insurance marketplace Healthcare reform in the United States Humana insurance Internal Revenue Code Internal Revenue Service Labor Mark Bertolini obamacare Omnibus legislation Patient Protection and Affordable Care Act Presidency of Barack Obama Statutory law Wall Street Journal

Back in the summer of 2016, as Obamacare rates were being set for the 2017 plan year, we repeatedly argued that the entire system was on the “verge of collapse” as premiums were soaring, risk pools were deteriorating and insurers were pulling out of exchanges all around the country leaving many Americans with just a single ‘option’ for health insurance (see “Obamacare On “Verge Of Collapse” As Premiums Set To Soar Again In 2017“).

And while Democrats may be all too willing to quickly dismiss our analysis, they may want to listen to the warnings of the CEO of one of the country’s largest health insurers who says that Obamacare is in a “death spiral.”  In speaking with the Wall Street Journal, Aetna CEO Mark Bertolini said, among other things, that the “risk pools are deteriorating in the ACA” to a point that it would inevitably result in more withdrawals this year.   Per The Hill:

“It’s not going to get any better; it’s getting worse.”

“That logic shows just how much the risk pools are deteriorating in the ACA,” Bertolini said.

He added: “I think you will see a lot more withdrawals this year. … There isn’t enough money in the ACA as structured, even with the fees and taxes, to support the population that needs to be served.”

“It is in a death spiral,” he said, but did not say whether Aetna would participate in the exchanges in 2018.


And, while his commentary was mostly doom and gloom, if there was one silver lining from Bertolini’s interview, it was his acknowledgement that at least “mathematics education in the United States is working” since consumers seem to be able to run the simple math required to figure out that paying ~$12,000 per year in premiums for a family of 4, plus $6,000 in deductibles, all for a service they never use, is a bad deal.

“You know that mathematics education in the United States is working when someone says, let me see, i’m going to pay this much premium, i’ve got a $6,000 deductible, and when I go to the doctor i’m going to pay cash…so premium, plus deductible, plus paying cash…why do I do this?  I’ll just pay the penalty and move on.”

“And so that risk keeps leaving and risk inside the pool keeps getting worse…the rates continue to chase it…and the participants start to leave, either at the bottom of the risk pool or the plans themselves.”

Of course, Bertolini’s comments today followed yesterday’s announcement from Humana that, due to an “unbalanced risk pool” (i.e. not enough healthy, young people paying massive premiums to balance out the risk of older, sicker customers), they would be pulling out of all Obamacare exchanges nationwide in 2018.  Per Humana’s press release:

Regarding the company’s individual commercial medical coverage (Individual Commercial), substantially all of which is offered on-exchange through the federal Marketplaces, Humana has worked over the past several years to address market and programmatic challenges in order to keep coverage options available wherever it could offer a viable product. This has included pursuing business changes, such as modifying networks, restructuring product offerings, reducing the company’s geographic footprint and increasing premiums.

All of these actions were taken with the expectation that the company’s Individual Commercial business would stabilize to the point where the company could continue to participate in the program. However, based on its initial analysis of data associated with the company’s healthcare exchange membership following the 2017 open enrollment period, Humana is seeing further signs of an unbalanced risk pool. Therefore, the company has decided that it cannot continue to offer this coverage for 2018. Through the remainder of 2017, Humana remains committed to serving its current members across 11 states where it offers Individual Commercial products. And, as it has done in the past, Humana will work closely with its state partners as it navigates this process.

Meanwhile, Trump seized on the announcement saying that as “Obamacare continues to fail” his administration would “repeal, replace & save healthcare for ALL Americans.”

Frankly, we’re shocked at all of this!  Turns out that whole “adverse selection bias” was a real thing…who could have known? 

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