Aetna becomes the latest of the major insurers and participants in the ACA (Affordable Care Act) exchanges to indicate that enough is enough. With estimated losses exceeding $400 million and mounting, they appear ready to cut their losses and leave the ACA exchange “marketplace”. This follows on the trend of other large health insurers such as United Health in limiting or ending their participation in the exchanges. Some 85% of those insured on the exchanges require government subsidies to pay their premiums. Therefore they are unlikely to be able to afford to buy individual policies outside of the exchanges.
The cynical perspective is to say we told you so regarding the ACA. Indeed their is every reason to believe that the ACA as crafted was designed to fail, thus facilitating the crisis needed for the advocacy of single payer system. This is certainly a reasonable belief given that the bill was essentially written by advocates of single payer.
Realizing that they could not achieve that goal, the bill as written was overly complex, voluminous (i.e. “pass it to see what is in it”) and too far reaching in its format. All of this was a faint to get a bill passed, even thought it was a totally partisan action, so that a box could be checked by the president and administration allowing them to say they had passed health reform. However, it was not totally meaningful health reform.
True health reform would have required a realignment of systems across the board. This would have included the possible expansion of Medicare (to say age 60), the expansion of eligibility for Medicaid and a national marketplace for health insurance. Basic regulation of health insurers nationally to include all subscriber eligibility, sales across state lines, removal of limits on annual and lifetime coverage, as well as premiums based on TOTAL population insured ratings instead of group rating could have made a real difference. This would also have included the VA (Veterans Administration) System so that veterans could receive routine, not combat related care, at any clinic, facility or hospital via a VA Health Insurance program. That would of course need to be combined with a reorganization of the VA Hospital System, which is often top heavy, overly bureaucratic and frequently offering redundant services that are available in the surrounding community in a more timely and efficient manner.
Suffice to say that the changes needed to make a true health insurance marketplace viable do exist without resorting to the “easy”, but in the end likely unwieldy, single government payer model. Real health insurance reform is possible but the political will to do it may be lacking now and the for the foreseeable future.
Aetna Joins Rivals in Projecting Loss on Affordable Care Act Plans for 2016
Can Obamacare Be Saved?
Aetna announces it will leave exchanges in 11 states