Aetna Faces Probe Over ‘Politically Motivated’ Obamacare Exit

12331351_lDive Brief:

  • A group of senators is seeking answers from Aetna about its abrupt decision to leave the ACA marketplaces following the DOJ’s challenge to the company’s proposed $37 billion merger with Humana.
  • The letter came Thursday from Senators Elizabeth Warren (D-Mass.), Bernie Sanders (I-Vt.), Edward J. Markey (D-Mass.), Sherrod Brown (D-Ohio), and Bill Nelson (D-Fla.).
  • While other insurers have also scaled back their ACA participation, the probe into Aetna comes in response to a letter from Aetna CEO Mark Bertolini in which the company is perceived to have directly threatened the government that it would leave the exchanges if the merger was not approved.

Dive Insight:

The reasoning for singling out Aetna, when numerous other insurers cited the same reasons to exit, comes down not only to the letter but to the company’s behavior leading up to the DOJ challenge.

The senators’ letter points out that Aetna had repeatedly expressed support and commitment regarding the ACA exchanges up through May 2016, and only began to suggest its participation to be conditional when the DOJ began to question the merger.

It also suggests Aetna purposely structured its deal with Humana from the beginning in a way that would force the DOJ to accept it, in part through a planned $1 billion payment to Humana if the deal was not completed by the end of 2016.

“Aetna’s letter describes a dangerous and irresponsible bet that the Justice Department would not block the deal because Aetna had structured the deal in a way that would cause significant damage to itself and, by extension, to the public exchanges, if it was blocked,” the senators’ letter argues, continuing, “Because the risks of the merger were obvious from the beginning, these actions are both inexplicable and irresponsible.”

Aetna is now faced with a list of questions to answer in the probe, primarily centered around what costs it will incur as a result of the DOJ challenge, its reasoning in structuring the deal in the way that it did, and when it determined its participation in the ACA would be contingent upon the deal.

Aetna spokesperson TJ Crawford provided a statement to Business Insider saying, “Singling Aetna out may be politically convenient during election season, but this letter ignores realities and takes the focus away from needed reforms. The ACA is not sustainable without bipartisan action that improves access, affordability and quality of care for consumers.”


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