View Full Version : AETNA is pulling out of the on exchange marketplace
"The insurer will stop offering policies on the exchanges in 11 of the 15 states where it currently operates"
http://money.cnn.com/2016/08/15/news/economy/aetna-obamacare/
"The company will continue to offer individual policies outside of the Obamacare exchanges in the vast majority of markets where it now does business. Off-exchange products are not eligible for federal subsidies."
"UnitedHealthcare (UNH), the nation's largest insurer that is expecting to lose about $1 billion on Obamacare policies in 2015 and 2016, is exiting most Obamacare exchanges in 2017. Humana (HUM) announced last month that it was pulling out of nearly 1,200 counties in eight states next year. Afterward, it will only be selling insurance on the exchanges in 156 counties in 11 states. Others, including several Blue Cross Blue Shield companies, are also scaling back."
None of this is surprising.
http://www.cnbc.com/2016/05/18/health-insurer-highmark-sues-us-over-obamacare-payments.html
One plan is suing the federal government because government didn't keep up their end of the bargain.
Just like UHC.
Shows it is failing. Considering I am involved in this industry, let me just say this:
The companies knew it was gunna put them in the RED when it came down to insuring folks this way; they progressed anyways, and are now using it as evidence to not be involved in the exchanges.
I don't blame them, they knew it was gunna be a hassle, and did the smart thing by showing it's a failure and backing out with legitimate evidence of such now.
Smart play by the companies.
ETA:
On this same topic, it's crazy entertaining how much Small Business insurance boomed this last year do avoid the exchanges to begin with.
It's not just AETNA. In VA, where they say they will continue to sell, they have a company that sells the Bronze plans named Coventry. They are cancelling the Bronze policies.
So it's worse than just leaving. There is no indication someone else will fill this gap.
Hillary said ObamaCare is basically her plan so hopefully this hurts her in the election. Trump really needs to run with this one.
ETA:
On this same topic, it's crazy entertaining how much Small Business insurance boomed this last year do avoid the exchanges to begin with.
How does that work? I thought small businesses were getting killed by ObamaCare.
So individuals who don't buy a service get fined...er..."taxed", but insurance companies that opt out of offering those services through Obamacare suffer no consequences or repercussions...
Business_Casual
08-19-16, 11:38
The goal is and always has been single payer. Don't be fooled. Falling out will only increase the need for a public option.
brickboy240
08-19-16, 12:09
Yes, this is a sort of controlled implosion. The damned thing was never supposed to work, be affordable or efficient.
Surprise!!!
FromMyColdDeadHand
08-19-16, 12:38
The goal is and always has been single payer. Don't be fooled. Falling out will only increase the need for a public option.
I agree on their strategy, but how going half-stupid didn't work, but we are supposed to support full stupid?
How does that work? I thought small businesses were getting killed by ObamaCare.
Haha.
That is pure misinformation. While a valid concern at first when the act was enacted. (ETA: Don't get me wrong, I am sure many groups have disbanded insurance to send their employees to the exchange, but it's been much more the opposite, from what I have seen)
I can't speak of my position, or what company (Rest Assured, it's one of the top 2), but trust me: small business is growing because of this within our company and many others.
I truly wish I could give you the exact growth percentages, but that would be a big no-no on my behalf.
ramairthree
08-19-16, 14:14
In the same manner that common sense and all other buzz words for gun control will have nothing to do with stopping violence and crime, with the end game being only military and police with arms,
Obamacare was never meant to provide affordable health care, with the end game being government medicine.
FromMyColdDeadHand
08-19-16, 15:32
Haha.
That is pure misinformation. While a valid concern at first when the act was enacted. (ETA: Don't get me wrong, I am sure many groups have disbanded insurance to send their employees to the exchange, but it's been much more the opposite, from what I have seen)
I can't speak of my position, or what company (Rest Assured, it's one of the top 2), but trust me: small business is growing because of this within our company and many others.
I truly wish I could give you the exact growth percentages, but that would be a big no-no on my behalf.
Small businesses are growing because of Obama-care?
Single payer would be the worst idea for the United States. Plenty of countries have socialized healthcare, yet people still flock to the US for legit life-saving, life-prolonging care. 40 years ago you would go to Europe for some crazy surgery like wanting to be a chick or something no rational doc would do here.
But, and please correct me if I am wrong, we have the better Oncologists and despite our horrid diets a long life expectancy.
How about we undo Obamacare, remove the tax bullshit, and let people be grown ups and buy their own insurance?
I have had my own insurance for quite a while and it has done nothing but skyrocket.
I did not qualify for Obamacare nor subsidies.
And the whole Car Insurance is like Health Insurance is a pretty goddamn ignorant analogy that people made. You can't penalize me if I don't own a car.
But I had no say in being born. But this had nothing to do with healthcare and everything to do with more taxes, more criminalization, more intrusiveness.
Besides people go to ERs for dumb shit that is just not an emergency:
VD checks
Pregnancy tests
"Mah elbow feel funny...mah elbow feel funny"
Those are just not emergencies.
Ugggghh
When you finally get to the bottom of this whole healthcare mess I would be willing to bet that none of these insurance companies are actually losing money, rather they can make more money by taking the action they are taking.
Everybody listens to doctors, hospital administrators, and insurance companies piss and moan about healthcare costs, biggest beef for some is medicaid and medicare - the reality is that doctors don't lose money taking those patients, they just make more on other patients.
Nobody (I hope) is against a person who has the devotion and smarts to get through med school, making a damn fine living. The issue, to me anyways, are the non-medical administrators at many of these hospitals that are making mid six, and even seven figure salaries.
Everybody in the United States should have read either the Time Magazine cover story Bitter Pill, or the book America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System both by Steven Brill:
...two of the book’s more powerful insights have to do with matters of industrial or bureaucratic structure. The first involves the health delivery system. Many people tend to look with alarm at consolidation in the insurance industry, and they focus on insurance company lobbying power as the essential cause of rising *prices. One of Brill’s critical insights is how consolidation in the hospital industry has actually decreased insurer power relative to provider power: Much of the rising cost of health care comes from overcharging by hospitals, not insurers.
Take the example of NewYork-*Presbyterian Hospital. Because of its size and array of serv*ices, no insurance company in the New York City area can sell policies if it doesn’t include NewYork-Presbyterian — therefore none of them are able to bargain aggressively for lower prices. This is not unique to NewYork-Presbyterian, nor is it even the most extreme example: Consolidation is the norm in many markets around the country. The hospital sets the price, and the insurer jumps to it.
The second insight has to do with the structure of management within the government. Brill argues that the initial website rollout failed in significant part because the “Office” in charge was demoted to a “Center,” in order to protect it from Republican funding cuts. In a wonderful passage, he recalls taking the train to Washington and reviewing his notes, noticing that when he asked different people who was in charge of establishing the federal exchange, he got seven different answers.
The subtitle — money, politics, back-room deals — refers primarily to the role the pharmaceutical industry plays in gutting any chance for cost effectiveness or price controls. According to the Center for Responsive Politics, the trade group Pharmaceutical Research and Manufacturers of America (PhRMA) has spent a quarter of a billion dollars since 1998 on lobbying. Brill shows what that means in day-to-day negotiations. Billy Tauzin, a former congressman and, until 2010, the trade group’s president, is the voice of Big Pharma in the book.
Tauzin is everywhere in the negotiations. He does not so much haggle as dictate policy, identifying the precise amount the industry would be willing to give up and still support the bill. Tauzin successfully guts comparative effectiveness research under Obamacare — Big Pharma’s profits are threatened by studies comparing which drugs work effectively at lower costs. With projections showing that the pharmaceutical industry will make at least $200 billion more with expanded coverage, Tauzin and his group “kick in” what amounts to $80 billion in givebacks, in exchange for killing any chance of containing the costs of drugs. He agrees to spend $70 million in political action funds supporting reform, and when pressured to raise his industry’s contribution to $120 billion, he sits tight, confident that he can kill the bill. Describing Tauzin’s position, Brill is matter-of-fact: “He knew they could never get 60 votes in the Senate if the drug makers switched sides and began financing a different set of ads, and he said so.”
“Depending on one’s view,” Brill writes, “this secret deal between Obama political operatives, PhRMA, staffers from the Senate Finance Committee who had just brokered a multibillion-dollar deal with *PhRMA, major unions and other liberal groups was proof that Washington was finally buckling down, coming together and getting the people’s business done; or it was Washington at its worst: liberal groups selling out to big business to accommodate all the groups’ special interests.”
Haha.
That is pure misinformation. While a valid concern at first when the act was enacted. (ETA: Don't get me wrong, I am sure many groups have disbanded insurance to send their employees to the exchange, but it's been much more the opposite, from what I have seen)
I can't speak of my position, or what company (Rest Assured, it's one of the top 2), but trust me: small business is growing because of this within our company and many others.
I truly wish I could give you the exact growth percentages, but that would be a big no-no on my behalf.
Are you talking about those companies below the 50 threshold? The company I work for is very large, and our insurance cost, copays, deductibles, and premiums have increased massively. My copay has increased 50%. My premium which my employer used to cover entirely, I now pay 10% of it. This is all in response to the increased cost related with ACA.
Sent from my iPhone using Tapatalk
Haha.
That is pure misinformation. While a valid concern at first when the act was enacted. (ETA: Don't get me wrong, I am sure many groups have disbanded insurance to send their employees to the exchange, but it's been much more the opposite, from what I have seen)
I can't speak of my position, or what company (Rest Assured, it's one of the top 2), but trust me: small business is growing because of this within our company and many others.
I truly wish I could give you the exact growth percentages, but that would be a big no-no on my behalf.
I can't make head nor tails of your sentence. Are you saying that the amount of small businesses buying health insurance from your company is growing? I own a small company with 20 employees. Because of the changes to the health care laws, this may be the last year we provide any insurance to our employees. Since pay scale in my company is low, most of them can get insurance through the exchange cheaper than I can provide. However, most of them also fall under the threshold where they'd have to pay any tax fine if they don't get insurance. This means they have no incentive to join our group. With the new rules on how we count participation in the group, I will fall under the required participants this year. At that point I am no longer going to provide any health insurance for my employees. It's a wash for me whether I go through the only provider in Alaska, Blue Cross, or use Obamacare. I will stick with Blue Cross for now even though I'm getting half the services for twice the monthly payment as I was spending 5 years ago.
Sorry for my delay in reply, had an event last night.
I can't say Obamacare has been the sole reason to boost our small group sales, only that it hasnt negatively impacted our small group sales. (In terms of losing our small business to the exchanges to put us in a decline of growth, I know we have lost groups, and potential sales, due to wage impacts; but the number of groups we have on books has grown, not fallen)
Yes, these are groups under 50, I cant speak for each group and each situation, but there are still penty of 3-5 people groups.
I also cannot speak for the impact to large business, as I dont have direct insight into that. I am sure I could find some reports, but I have to err on the side of caution with any conversation in these regards.
So, I wont say its a direct result of the Affordable Care Act, but I can say with certainty that it hasnt hurt our sales, we've had growth, not falling.
I also am not aware if they mean they will be pulling from the SHOP Exhanges or not too.
ETA:
I will also include that increase in premium and benefit reduction has happened to us all. Including those working for the large businesses even the insurance companies. I pay contributions on my benefits, far more than 10%, and I work for the company. Not to target you, or put a negative light on any comment, just want it known that ACA has impacted all of us, I will not contest that (that would be stupid of me, as well as would display a large amount of ignorance) but purely on the backing out of the exchanges, small business sales are still growing, and they grew significantly this year.
I would say it is a mixture of things, competitve pricings, marketing, ads, etc. But you all would be amazed at how many employers i speak with that despise ACA and insist on staying with the company direct. Political inspiration or what-have-you. Not all, maybe not even "a lot", but enough to be noticeable.
Also, I am not sure if anyone gets charged for their TRF (Transitional Reinsurance Fee). Some large employers do charge their employees, some do not. Mine does recoup the TRF from us as employees through bi-weekly paycheck deductions.
Let me offer our experience: Our small business of 65 employees (and of course, their insured family members) saw a 40% increase in the 2015/16 year. Because of this, we had to cut out our drug plan, up our individual deduction to $5000 and put a larger percentage of the 'split' (what we paid and what the individual paid) onto the individual. The premium for this is in excess of $500,000 now. On top of that, our insurer paid 125% of our premium OUT in benefits (it only takes ONE insured - in this case a out-of-network employee's spouse who had incurable pancreatic cancer that was paid out over $250k in benefits) to utterly destroy your chances of keeping it under control. We are now hearing rumors of another 40% increase for the 2017 year. That's more money than we MADE. We will soon be faced with doing the worst possible thing - put people out on the Ocare market just to survive. The plans they offer give LESS and cost MORE than the plan we have (we checked). So basically we are left screwing our employees just to survive.
Obamacare is destroying small businesses. It was meant to fail from day ONE - in order to hasten the arrival of single-payer. Now the government has control of your healthcare, too.
brickboy240
08-23-16, 13:38
This is one of those issues that the Trump campaign has passed on but if talked about enough, would make a convincing case against Hillary. The numbers are in and there are enough facts to make a case that Hillary and Barack's dreams of this ACA have been a disaster.
Don't look for big media to shine much light on this....it is up to the right to bring this front and center.
A very timely article. How Obamacare is splitting into two. (http://thehill.com/policy/healthcare/292019-how-obamacare-is-splitting-in-two)
According to an analysis from the consulting firm Avalere, as of now, there will be just one insurer offering ObamaCare coverage next year in seven states: Alabama, Oklahoma, South Carolina, Wyoming, Alaska, North Carolina and Kansas. It is possible that more insurers could enter these markets before next year.
In one county in Arizona, there might not be an ObamaCare plan available at all.
Aetna had been the only insurer offering a plan in Pinal County. Unless federal and state officials can find another insurer to fill the void in 2017, the county’s 400,000 residents will not be able to buy coverage on an ObamaCare exchange.
The dearth of options in rural, sparsely populated areas is a far cry from what Democrats promised when selling the Affordable Care Act...
In states like Oklahoma, the reality is different, with just one insurer to choose from in the online marketplace...
I don't know how it got to the point where people want to just surrender their lives to a "promise" of government care. It's like people who defecate 7 kids and then bemoan having 7 kids.
No self accountability. I'm not rich. I likely won't be (unless you count having Jesus). I am merely happy with what I have. I don't blame anyone else nor do I hate on the mysterious 1%. I could've gone to med school, got my masters, etc but I was too busy ghetto hopping. Could have gotten a much higher paying job but did what I wanted to do and am looking to do something different because burn out But that is my problem.
Captain of my own fate. Invictus.
I go to the doctor I go to for the same reason I take my car to the same garage. I don't get BSed and I get the results I want. I don't need Big Brother in that equation.
I hate having to remind people that I reached age of majority quite a long time ago.
I hate this BS of the Government wanting to treat us like we are all 15. No. We are not.
It is not my fault x million amount of people put getting hair did and rims over a monthly insurance payment. Nor is it my fault some heady and flighty young people would rather buy dope or guitars over a monthly payment.
I know I got issues. I know I got injuries.
I was responsible. Yet, I am getting punished because lol Democrats.
Some people think I am well off, but they don't know that over the years I:
Stayed out of debt as much as possible
Worked extra, over, multiple jobs
Forewent family and children
Insisted upon going dutch
Was not above picking up/recycling cans.
Not above change jars.
Not above skipping meals.
Not above a used car
Not above using "Cold Equations" style travel plans where gas prices and distance was a factor.
Not above being a miser.
Prefer to pay cash
So if you want to mortgage a house you can't afford or lease a vehicle you can't buy or pop out a bunch of kids or marry and divorce bitches who take you to the cleaners......
....how am I responsible again?
I'm doing me until I can afford to do otherwise
I don't know how it got to the point where people want to just surrender their lives to a "promise" of government care. It's like people who defecate 7 kids and then bemoan having 7 kids.
No self accountability. I'm not rich. I likely won't be (unless you count having Jesus). I am merely happy with what I have. I don't blame anyone else nor do I hate on the mysterious 1%. I could've gone to med school, got my masters, etc but I was too busy ghetto hopping. Could have gotten a much higher paying job but did what I wanted to do and am looking to do something different because burn out But that is my problem.
Captain of my own fate. Invictus.
I go to the doctor I go to for the same reason I take my car to the same garage. I don't get BSed and I get the results I want. I don't need Big Brother in that equation.
I hate having to remind people that I reached age of majority quite a long time ago.
I hate this BS of the Government wanting to treat us like we are all 15. No. We are not.
It is not my fault x million amount of people put getting hair did and rims over a monthly insurance payment. Nor is it my fault some heady and flighty young people would rather buy dope or guitars over a monthly payment.
I know I got issues. I know I got injuries.
I was responsible. Yet, I am getting punished because lol Democrats.
Some people think I am well off, but they don't know that over the years I:
Stayed out of debt as much as possible
Worked extra, over, multiple jobs
Forewent family and children
Insisted upon going dutch
Was not above picking up/recycling cans.
Not above change jars.
Not above skipping meals.
Not above a used car
Not above using "Cold Equations" style travel plans where gas prices and distance was a factor.
Not above being a miser.
Prefer to pay cash
So if you want to mortgage a house you can't afford or lease a vehicle you can't buy or pop out a bunch of kids or marry and divorce bitches who take you to the cleaners......
....how am I responsible again?
I'm doing me until I can afford to do otherwise
It's very saddening to hear, and very demoralizing.
But, rest assured, there are youngins feeling the same way. Many are willing to fight for this point, many more would rather do neither and fit into your exact description of money issues.
I never got me no college, but I did well and focused growing up and wound up in a white collar job making more than my father did after nearly 10 years in on his career with the same employer until they cut him loose due to budget bullcrap.
I got lucky, took risks, and am not trying to live as a teenager anymore. Is it a battle? Sure.
But we should have seen our parents doing the hump, why would we think it could be easy?
I dunno, I guess my ignorance could be at play here, but I agree with your post.
Let me offer our experience: Our small business of 65 employees (and of course, their insured family members) saw a 40% increase in the 2015/16 year. Because of this, we had to cut out our drug plan, up our individual deduction to $5000 and put a larger percentage of the 'split' (what we paid and what the individual paid) onto the individual. The premium for this is in excess of $500,000 now. On top of that, our insurer paid 125% of our premium OUT in benefits (it only takes ONE insured - in this case a out-of-network employee's spouse who had incurable pancreatic cancer that was paid out over $250k in benefits) to utterly destroy your chances of keeping it under control. We are now hearing rumors of another 40% increase for the 2017 year. That's more money than we MADE. We will soon be faced with doing the worst possible thing - put people out on the Ocare market just to survive. The plans they offer give LESS and cost MORE than the plan we have (we checked). So basically we are left screwing our employees just to survive.
Obamacare is destroying small businesses. It was meant to fail from day ONE - in order to hasten the arrival of single-payer. Now the government has control of your healthcare, too.
Your story is very eye-opening. I can only imagine what that must feel like from your perspective.
Having to give the news to your employees, moral impacts, I am truly sorry that things like this happen.
I don't know what is going on, really. Very possible that other insurance companies are hurting in their small group sales, I truly have no other perspective than my own.
I am still sorry, nonetheless. While it may be what I do for a living, I do fight for the small business guys.
My position allows me a lot of one on one time with our consumers, and because of this, I get to chat with them about the tough stuff.
When ACA comes up, they're usually pretty shocked to hear it's a nightmare for us too.
While I cant even begin to comprehend the stresses and troubles you're feeling, I truly do hope the system is fixed through our political actions sooner, than before its damaged beyond repair.
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