Suit: Aetna Profitable When It Left State Obamacare Market

Jan 26, 2017

Insurer Aetna was making a profit selling health insurance under the Affordable Care Act when it exited Florida.

Aetna stopped selling insurance in Florida on the federal exchange last year, after the U.S. Department of Justice announced it would sue to block its merger with Humana.

The issue is intent: Did Aetna pull out of the Affordable Care Act in Florida because it was bad business, as the company said publicly? Or did Aetna pull out because it wanted to avoid a court’s scrutiny of the merger with Humana?

In a 158-page ruling, U.S. District Judge John Bates concluded that Aetna added in Florida, Georgia and Missouri to the list of states where it would stop selling individual health plans under Obamacare after the U.S. Department of Justice announced it was suing. That was to avoid government scrutiny in the troublesome counties so the merger could happen.

In an email, Aetna’s Florida Market President Christopher Ciano – who had no involvement in the decision – wrote he was really disappointed Aetna was pulling out of Florida.

“I just can’t make sense out of the Florida decision . . . Never thought we would pull the plug all together. Based on the latest run rate data . . . we are making money from the on-exchange business. Was Florida’s performance ever debated?”

The judge ruled that if Aetna and Humana merged, it would be anti-competitive in three Florida counties: Volusia, Broward and Palm Beach. The judge added that it was likely that Aetna would start selling again in Florida after 2017, although the future of Obamacare is in question.

Aetna’s departure means Florida Blue is now the only insurance company selling individual health plans in every county in Florida, a state that leads the nation in the number of people buying insurance under the Affordable Care Act.

Check here to read the lawsuit.