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data-mobilepath="/us/entry/57b3d747e4b04ff883996a13" data-sharingimage="http://img.huffingtonpost.com/asset/360_216/57b3d8171700002c00d1f42c.jpeg?cache=2f6t1kirdm" data-sharingtitle="Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger" data-sharingtweetname="HuffPostPol" data-sharingtweettext="Aetna+warned%3A+Approve+our+merger+or+we%27ll+bail+on+Obamacare+%E2%9E%A1%EF%B8%8F+by+%40CitizenCohn+and+%40JeffYoung" data-sharingurl="http://www.huffingtonpost.com/entry/aetna-obamacare-pullout-humana-merger_us_57b3d747e4b04ff883996a13" data-socialmessaging="{}" dir="ltr" id="us_57b3d747e4b04ff883996a13" path="/us/entry/us_57b3d747e4b04ff883996a13" type="article"> <div id="left-rail-trending"></div> <div class="entry__container"> <header class="entry__header" data-beacon="{"p":{"mnid":"headline"}}"> <span class="entry-eyebrow"> <a class="entry-eyebrow__link" data-beacon="{"p":{"mpid":"top_section","lnid":"politics","plid":"/section/politics"}}" href="/web/20160818180421/http://www.huffingtonpost.com/section/politics">POLITICS </a></span> <div class="headline"> <h1 class="headline__title">Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger</h1> <h2 class="headline__subtitle">Give us our merger or we'll quit Obamacare, the insurer told Justice Department officials in a July letter.</h2> </div> <div class="timestamp"> <span class="timestamp__date--published">08/17/2016 01:49 am ET</span> | <span class="timestamp__date--modified"> <strong>Updated</strong> 11 hours ago </span> </div> <div class="js-horizontal-share share-bar share-bar--horizontal" data-beacon="{"p":{"mnid":"headline_share_bar"}}"> <div class="share-bar__social-counts"> <span class="share-bar__social-counts__number">26k</span> </div> <ul class="share-bar__list"> <li class="bN facebook share-bar__item" data-beacon="{"p":{"lnid":"facebook","mpid":1}}" data-type="facebook"> <a class="share-bar__item-link" href="#" target="_blank"></a> </li> <li 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url(https://web.archive.org/web/20160818180421im_/http://img.huffingtonpost.com/asset/100_100/55e0cd5f1700001900568e96.jpg);"></div> </a><div class="author-card__details"> <span class="author-card__details-container"> <a class="author-card__details__link" data-beacon="{"p":{"lnid":"author"}}" data-plid="jonathan-cohn" href="/web/20160818180421/http://www.huffingtonpost.com/author/jonathan-cohn"><span class="author-card__details__name">Jonathan Cohn</span> </a><span class="author-card__social-container"> <a class="author-card__social author-card__social--facebook" data-beacon="{"p":{"lnid":"author_facebook"}}" href="https://web.archive.org/web/20160818180421/http://facebook.com/CitizenCohn" target="_blank"></a> <a class="author-card__social author-card__social--twitter" data-beacon="{"p":{"lnid":"author_twitter"}}" href="https://web.archive.org/web/20160818180421/http://twitter.com/citizencohn" target="_blank"></a> </span> </span> <span class="author-card__microbio"> Senior National Correspondent, The Huffington Post </span> </div> </div> <div class="author-card"> <a data-beacon="{"p":{"lnid":"author_image","plid":"jeffrey-young"}}" href="/web/20160818180421/http://www.huffingtonpost.com/author/jeffrey-young"><div class="author-card__headshot" style="background-image: url(https://web.archive.org/web/20160818180421im_/http://img.huffingtonpost.com/asset/100_100/55a534691700005f04326cb5.jpg);"></div> </a><div class="author-card__details"> <span class="author-card__details-container"> <a class="author-card__details__link" data-beacon="{"p":{"lnid":"author"}}" data-plid="jeffrey-young" href="/web/20160818180421/http://www.huffingtonpost.com/author/jeffrey-young"><span class="author-card__details__name">Jeffrey Young</span> </a><span class="author-card__social-container"> <a class="author-card__social author-card__social--facebook" data-beacon="{"p":{"lnid":"author_facebook"}}" href="https://web.archive.org/web/20160818180421/http://facebook.com/jcydc" target="_blank"></a> <a class="author-card__social author-card__social--twitter" data-beacon="{"p":{"lnid":"author_twitter"}}" href="https://web.archive.org/web/20160818180421/http://twitter.com/JeffYoung" target="_blank"></a> </span> </span> <span class="author-card__microbio"> Senior Reporter, The Huffington Post </span> </div> </div> </div> </div> </header> <div class="entry__content js-entry-content"> <div class="entry__body js-entry-body"> <div class="top-media" data-beacon="{"p":{"mnid":"top_media"}}"> <div class="top-media--image"> <figure class="content-list-component image"> <img class="image__src" src="https://web.archive.org/web/20160818180421im_/http://img.huffingtonpost.com/asset/scalefit_630_noupscale/57b3d8171700002c00d1f42c.jpeg?cache=2f6t1kirdm"/> <div class="image__credit js-image-credit"> Simon Dawson/Bloomberg via Getty Images </div> <figcaption class="image__caption js-image-caption"> Aetna CEO Mark Bertolini told federal officials last month that his company would retreat from Obamacare if its merger with Humana met resistance. </figcaption> </figure> </div> <script></script> <iframe style="display: none;"></iframe> </div> <div class="share-bar-highlight js-highlight hidden"> <a class="share-bar-highlight__twitter js-highlight-share-button" data-beacon="{"p":{"lnid":"twitter","mnid":"entry_text","plid":"http://www.huffingtonpost.com/entry/aetna-obamacare-pullout-humana-merger_us_57b3d747e4b04ff883996a13"}}" data-type="twitter"></a> <a class="share-bar-highlight__facebook js-highlight-share-button" data-beacon="{"p":{"lnid":"facebook","mnid":"entry_text","plid":"http://www.huffingtonpost.com/entry/aetna-obamacare-pullout-humana-merger_us_57b3d747e4b04ff883996a13"}}" data-type="facebook"></a> </div> <div class="content-list-component text"><p><span style="font-weight: 400;">The big health care news this week came from Aetna, which announced on Monday it was dramatically </span><a href="https://web.archive.org/web/20160818180421/http://www.bloomberg.com/news/articles/2016-08-16/aetna-quits-most-obamacare-markets-joining-other-major-insurers"><span style="font-weight: 400;">scaling back</span></a><span style="font-weight: 400;"> participation in the Affordable Care Act ― thereby </span><a href="https://web.archive.org/web/20160818180421/http://www.bloomberg.com/news/articles/2016-08-16/insurer-exits-from-obamacare-turn-few-choices-into-none"><span style="font-weight: 400;">reducing insurer competition</span></a><span style="font-weight: 400;"> and forcing customers scattered across 11 states to find different sources of coverage next year.</span></p> <p><span style="font-weight: 400;">Aetna officials said the pullout was necessary because of Obamacare’s problems ― specifically, </span><a href="https://web.archive.org/web/20160818180421/http://www.wsj.com/articles/aetna-tops-views-stops-aca-expansion-plans-1470134736"><span style="font-weight: 400;">deep losses</span></a><span style="font-weight: 400;"> the insurer was incurring in the law’s health insurance exchanges. </span></p> <p><span style="font-weight: 400;">But the move also was directly related to a Department of Justice decision to block the insurer’s potentially lucrative merger with Humana, according to </span><a href="https://web.archive.org/web/20160818180421/http://big.assets.huffingtonpost.com/AetnaDOJletter.pdf"><span style="font-weight: 400;">a letter</span></a><span style="font-weight: 400;"> from Aetna’s CEO obtained by The Huffington Post.</span></p> <p><span style="font-weight: 400;">Paired with some </span><a href="https://web.archive.org/web/20160818180421/http://kff.org/health-reform/issue-brief/analysis-of-2016-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/"><span style="font-weight: 400;">looming rate increases</span></a><span style="font-weight: 400;"> for next year’s health plans, the abrupt departure of Aetna has triggered new worries that </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/news/health-care-reform/"><span style="font-weight: 400;">Obamacare</span></a><span style="font-weight: 400;"> ― a subsidized public-private system of health insurance plans competing for beneficiaries ― is in serious trouble and may even be unsustainable. </span></p> <p><span style="font-weight: 400;">That’s despite</span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/obamacare-uninsured-rates_us_56b90b93e4b08069c7a872dd?evjrwm7luhe0vvlsor"><span style="font-weight: 400;"> millions who have obtained coverage</span></a><span style="font-weight: 400;"> through these marketplaces, contributing to a </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/obamacare-uninsured-rate-2015_us_5739d280e4b077d4d6f37d99"><span style="font-weight: 400;">historically low uninsured rate</span></a><span style="font-weight: 400;">. It’s also despite optimism about Obamacare from at least some insurers and experts ― optimism that Aetna’s own leaders had expressed just a few months ago.</span></p> <p><span style="font-weight: 400;">Publicly, Aetna representatives this week framed their about-face as a reaction to losses the company was taking on Obamacare customers, and in particular figures from the second quarter of 2016 that the company had just analyzed, showing them to be </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/obamacare-enrollees-are-sick_us_56face7be4b0143a9b497571?cbqqlp48fztyidaemi"><span style="font-weight: 400;">sicker and costlier</span></a><span style="font-weight: 400;"> than predicted. </span></p> <p><span style="font-weight: 400;">When reporters on Monday asked whether Aetna was also reacting to the administration’s attempt to thwart its merger with Humana, company officials brushed off the questions, according to accounts in the </span><a href="https://web.archive.org/web/20160818180421/http://www.courant.com/business/hc-aetna-second-quarter-earnings-20160802-story.html"><span style="font-weight: 400;">Hartford Courant</span></a><span style="font-weight: 400;">, </span><a href="https://web.archive.org/web/20160818180421/http://www.politico.com/story/2016/08/aetna-obamacare-backers-227086"><span style="font-weight: 400;">Politico</span></a><span style="font-weight: 400;"> and </span><a href="https://web.archive.org/web/20160818180421/http://www.usatoday.com/story/news/politics/2016/08/16/aetna-changes-add-consumer-pain-regulator-pressure/88829392/"><span style="font-weight: 400;">USA Today</span></a><span style="font-weight: 400;">.</span></p></div> <blockquote class="content-list-component pull-quote"> <span class="quote">It is very likely that we would need to leave the public exchange business entirely and plan for additional business efficiencies should our deal ultimately be blocked.</span> <span class="attribution">Aetna CEO Mark Bertolini to the Department of Justice, July 5</span> </blockquote> <div class="content-list-component text"><p><span style="font-weight: 400;">But just last month, in </span><a href="https://web.archive.org/web/20160818180421/http://big.assets.huffingtonpost.com/AetnaDOJletter.pdf"><span style="font-weight: 400;">a letter</span></a><span style="font-weight: 400;"> to the Department of Justice, Aetna CEO Mark Bertolini said the two issues were closely linked. In fact, he made a clear threat: If President </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/news/barack-obama/"><span style="font-weight: 400;">Barack Obama</span></a><span style="font-weight: 400;">’s administration refused to allow the merger to proceed, he wrote, Aetna would be in a worse financial position and would have to withdraw from most of its Obamacare markets, and quite likely all of them.</span></p> <p><span style="font-weight: 400;">Bertolini penned the letter, which The Huffington Post obtained through a Freedom of Information Act request, on July 5 ― 16 days before the Justice Department announced </span><a href="https://web.archive.org/web/20160818180421/http://www.bloomberg.com/news/articles/2016-07-21/anthem-cigna-sued-by-u-s-seeking-to-block-insurer-merger"><span style="font-weight: 400;">it would fight</span></a><span style="font-weight: 400;"> the Humana deal. The department had asked Aetna how, if at all, a decision on the proposed merger would affect Aetna’s willingness to offer insurance through the exchanges.</span></p> <p>Bertolini responded bluntly. Aetna supported the law’s goal to expand coverage and planned to increase its exchange offerings next year, in the hopes that the exchanges would stabilize as enrollment grew, he wrote.</p> <p>But if the Justice Department were to block the merger, Bertolini warned, Aetna could no longer sustain the losses from its exchange business, forcing it to sharply change direction:</p> <blockquote> <p><span style="font-weight: 400;">[I]f the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses. Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint .... [I]nstead of expanding to 20 states next year, we would reduce our presence to no more than 10 states .… [I]t is very likely that we would need to leave the public exchange business entirely and plan for additional business efficiencies should our deal ultimately be blocked. By contrast, if the deal proceeds without the diverted time and energy associated with litigation, we would explore how to devote a portion of the additional synergies ... to supporting even more public exchange coverage over the next few years.</span></p> </blockquote> <p><span style="font-weight: 400;">To Obamacare critics, Aetna’s retreat is proof the law is failing. To supporters, it shows the company was using its participation in Obama’s signature domestic policy initiative as a bargaining chip in order to secure approval of a </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/health-insurance-mega-mergers-attract-powerful-enemy_us_5643a001e4b0603773477931"><span style="font-weight: 400;">controversial business deal</span></a><span style="font-weight: 400;">.</span></p> <p><span style="font-weight: 400;">Advocates on both sides can cite at least some evidence to support their views. While </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/obamacare-health-insurance_us_573a00dce4b060aa781ad6cc?7jwt7qbwozfmq85mi"><span style="font-weight: 400;">some insurers are making money</span></a><span style="font-weight: 400;"> on Obamacare, most of the large, publicly traded national insurers now offering coverage on the exchanges are losing money, basically for the same reasons that Aetna cites. Aetna’s shift in strategy followed similar maneuvers by</span><span style="font-weight: 400;"><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/unitedhealth-group-obamacare-exchanges_us_571554d9e4b0018f9cbade3b?zy7rpd6fn701cerk9"> UnitedHealth Group</a>,</span><span style="font-weight: 400;"> </span><a href="https://web.archive.org/web/20160818180421/http://www.politico.com/story/2016/07/humana-obamacare-markets-225963"><span style="font-weight: 400;">Humana</span></a><span style="font-weight: 400;"> and some smaller insurers.</span></p> <p><span style="font-weight: 400;">If the exchanges do not attract more participants who are in relatively good health, then companies will likely have to keep raising rates ― to the point where some people who have to pay for insurance directly, especially those who receive little or no federal subsidies, would decide it’s too expensive.</span></p> <p><span style="font-weight: 400;">Notably, however, Anthem and Cigna, two other health insurance giants whose pending merger the Justice Department also opposes, have not said they plan to alter course on the exchanges next year, </span><a href="https://web.archive.org/web/20160818180421/http://www.wsj.com/articles/anthem-raises-outlook-reiterates-cigna-purchase-plans-1469617063"><span style="font-weight: 400;">despite financial struggles</span></a><span style="font-weight: 400;">. </span></p> <p><span style="font-weight: 400;">Anthem is a major player in this market segment, and Cigna intends to </span><a href="https://web.archive.org/web/20160818180421/http://www.chicagobusiness.com/article/20160727/NEWS03/160729841/why-cigna-plans-to-sell-through-more-health-exchanges-in-2017"><span style="font-weight: 400;">offer plans in more states</span></a><span style="font-weight: 400;"> that it currently does. Of course, investors may pressure those companies to reconsider in response to the moves by Aetna, Humana and UnitedHealth Group.</span></p> <p><span style="font-weight: 400;">Furthermore, Aetna’s posture on the exchanges changed pretty radically after the Justice Department announced that it was suing to block the Humana merger. </span></p> <p><span style="font-weight: 400;">As recently as April, </span><a href="https://web.archive.org/web/20160818180421/http://finance.yahoo.com/news/edited-transcript-aet-earnings-conference-205937826.html"><span style="font-weight: 400;">Bertolini told investors</span></a><span style="font-weight: 400;"> that Aetna could sustain losses on the exchanges for the time being, because participation still represented a relatively cheap way to acquire new customers ― particularly since the program was bound to have kinks in the early years. </span></p> <p><span style="font-weight: 400;">Bertolini defended Aetna’s exchange business at the time: </span></p> <blockquote> <p>We see this as a good investment, hoping that we have an administration and a Congress that will allow us to change the product like we change Medicare every year, and we change Medicaid every year. But we haven’t been able to touch this product because of the politics.</p> </blockquote> <p><span style="font-weight: 400;">Since that earnings call, Aetna officials have warned that their assessment of the financial returns from the exchange business was dimming, even as the firm’s other lines of business ― such as employer-provided health benefits, Medicare and Medicaid ― continued to thrive. On Monday, they pointed to that new information as a reason for pulling back on the exchanges.</span></p> <p><span style="font-weight: 400;">T.J. Crawford, an Aetna spokesman, reiterated that argument in an email to The Huffington Post Tuesday. </span></p> <p><span style="font-weight: 400;">“We gained full visibility into our second quarter individual public exchange results,” Crawford wrote, “which ― similar to other participants on the public exchanges ― showed a significant deterioration. That deterioration, and not the DOJ challenge to our Humana transaction, is ultimately what drove us to announce the narrowing of our public exchange presence for the 2017 plan year.”</span></p> <p><span style="font-weight: 400;">Aetna’s shift in strategy, whatever the reasons, underscores </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/obamacare-sign-up-deadline_us_56ac059be4b00b033aaf3eef"><span style="font-weight: 400;">the difficulties</span></a><span style="font-weight: 400;"> facing this new market for people who don’t get health insurance through their employers or from a government program like Medicare and Medicaid.</span></p> <p><span style="font-weight: 400;">The departures of health insurers from some states, along with the collapse of most of the nonprofit co-op plans created under the Affordable Care Act, also means many consumers will see fewer choices when sign-ups begin in November for 2017 coverage.</span></p> <p><span style="font-weight: 400;">At the same time, other insurers, including </span><a href="https://web.archive.org/web/20160818180421/http://www.cnbc.com/2016/08/16/obamacare-is-working-for-us-says-florida-blue-ceo.html"><span style="font-weight: 400;">regional Blue Cross and Blue Shield plans</span></a><span style="font-weight: 400;"> in states like Florida, Michigan and New Jersey, along with companies </span><a href="https://web.archive.org/web/20160818180421/http://www.rollcall.com/news/policy/medicaid-plans-succeed-obamacare-others-struggle"><span style="font-weight: 400;">like Molina Healthcare and Centene</span></a><span style="font-weight: 400;"> that previously specialized in covering Medicaid beneficiaries, are either</span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/obamacare-health-insurance_us_573a00dce4b060aa781ad6cc?7jwt7qbwozfmq85mi"><span style="font-weight: 400;"> profitable already or say they plan to continue their investment in this market. </span></a> </p></div> <figure class="content-list-component image"> <img class="image__src" src="https://web.archive.org/web/20160818180421im_/http://img.huffingtonpost.com/asset/scalefit_630_noupscale/56df40631500002a000b169f.png"/> <div class="image__credit js-image-credit"> The Huffington Post </div> </figure> <div class="content-list-component text"><p><span style="font-weight: 400;">As Bertolini indicated in April, strengthening these marketplaces and making coverage more secure for the low- and middle-income people who rely on it likely will require changes in the law. Given the relentless political toxicity afflicting anything Obamacare-related, legislative solutions aren’t likely in the near term.</span></p> <p><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/news/democratic-party/"><span style="font-weight: 400;">Democratic</span></a><span style="font-weight: 400;"> presidential nominee </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/news/hillary-clinton/"><span style="font-weight: 400;">Hillary Clinton</span></a><span style="font-weight: 400;"> has proposed </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/hillary-clinton-obamacare_us_5602b956e4b00310edf954cd"><span style="font-weight: 400;">a number of fixes</span></a><span style="font-weight: 400;"> for the health insurance market, including the creation of a government-run </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/clinton-public-option_us_5781064fe4b01edea78e1cf1"><span style="font-weight: 400;">public option plan</span></a><span style="font-weight: 400;"> that would be available everywhere, and allowing pre-retirees to buy Medicare coverage. Clinton also has called for offering more generous subsidies to cover families with high health care costs.</span></p> <p><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/news/donald-trump/"><span style="font-weight: 400;">Donald Trump</span></a><span style="font-weight: 400;">, the </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/news/republican-party/"><span style="font-weight: 400;">GOP</span></a><span style="font-weight: 400;"> White House nominee, follows the party line on the Affordable Care Act, which is that it should be repealed and replaced with some other set of reforms that he has </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/trump-obamacare-repeal_us_56e6d019e4b0860f99d98990"><span style="font-weight: 400;">barely defined</span></a><span style="font-weight: 400;">. </span><span style="font-weight: 400;">House Speaker </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/news/paul-ryan/"><span style="font-weight: 400;">Paul Ryan</span></a><span style="font-weight: 400;"> (R-Wis.) released a </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/the-house-gop-obamacare-replacement-has-arrived_us_5768616be4b015db1bca595e"><span style="font-weight: 400;">broad outline</span></a><span style="font-weight: 400;"> of a GOP health plan, but it doesn’t seek the same goals as Obamacare ― especially when it comes to the uninsured and people with pre-existing conditions. </span></p> <p><span style="font-weight: 400;">Indeed, the aim of Trump and Ryan in repealing Obamacare would result in </span><a href="https://web.archive.org/web/20160818180421/http://www.huffingtonpost.com/entry/what-would-happen-if-you-repealed-obamacare_us_57712f89e4b0dbb1bbbb1272"><span style="font-weight: 400;">roughly 20 million people</span></a><span style="font-weight: 400;"> losing their coverage, which would cause disruption on a far greater scale that Aetna’s decision.</span></p> <p><em><span style="font-weight: 400;">Ryan Grim contributed reporting.</span></em></p></div> <script></script> <iframe style="display: none;"></iframe> <script class="article-bottom-ad-script-template" type="text/template"> </script> <div class="advertisement before_related_media" data-beacon="{"p":{"mnid":"ad","lnid":"before_related_media"}}"> <div class="basic_image_widget_a"> <a href="https://web.archive.org/web/20160818180421/http://at.atwola.com/adlink/3.0/5113.1/4177548/1/16/AdId=8596742;BnId=1;link=https://www.hillaryclinton.com/forms/om-hvf-join/?utm_medium=om2016&utm_source=dcm-huffpostwidget-999554&utm_campaign=lb-branded&utm_content=believeIWH" target="_blank"> <img src="https://web.archive.org/web/20160818180421im_/http://modulous.huffpost.com/2016/08/03/1470247029-35b3cbb9-d453-4adf-95a7-c28dfeeac7fe.png"/> </a> <img 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