Thousands of Aetna policyholders in Texas will have to find new health care coverage next year after Aetna, the country’s third-largest insurer, said it is leaving the federal insurance marketplace created by President Barack Obama’s Affordable Care Act.

Aetna is among several large insurers losing money selling their plans in the “Obamacare” marketplaces, raising questions about the stability and future of the business.

Aetna spokeswoman Anjie Coplin didn’t say how many policyholders will be affected by the recent move, but the company’s May rate filing with the Texas Department of Insurance for 2017 showed that the insurer had 84,058 clients in Texas in the individual market. The filing doesn’t specify how many of people bought plans on the federal marketplace and how many purchased policies outside the marketplace. In Texas, more than 1.2 million people had signed up for plans on the exchange, according to federal numbers released in January.

“These changes do not affect coverage for the 2016 plan year,” Coplin said. “We will communicate options to impacted members before the 2017 open enrollment period begins, and provide resources to assist them in transitioning to other plans as appropriate.”

Stacey Pogue, a senior policy analyst for the Austin-based Center for Public Policy Priorities, speculated that Aetna’s health plans — or at least those in Travis County — have tended to be more expensive compared with many of the options from the insurer’s competitors.

Of the 25 silver-level plans in Travis County in 2016, 20 were less expensive than Aetna’s plans, said Pogue, whose nonprofit organization advocates for low- and middle-income Texans.

“So I suspect they didn’t get too much market share based on the fact that I understand most enrollees pick one of the cheapest silver plans,” she said in an email to the American-Statesman.

In Travis County, a total of seven insurers marketed 76 different policies on the exchange in 2016. Aetna offered four, Pogue said.

Mark Bertolini, chairman and CEO of Aetna, warned of the company’s likely exit from the marketplace on the insurer’s quarterly earnings call on Aug. 2.

He said the company’s small group and individual products associated with the Affordable Care Act’s marketplace were suffering.

“In light of the disappointing year-to-date performance and updated 2016 projections for our individual on and off exchange products, combined with the significant structural challenges facing the public exchanges, we believe it is only prudent to reassess our level of participation on the public exchanges,” Bertolini said on the call.

Aetna is just the latest health insurer to retreat from the Affordable Care Act’s public exchanges by announcing a pullback that will further deplete customer choices in many pockets of the country.

Aetna plans to leave nearly 70 percent of the counties in which it currently sells coverage as it trims exchange participation to four states in 2017, down from 15 this year. The insurer’s announcement comes after UnitedHealth and Humana detailed their own exchange pullbacks for 2017 and after more than a dozen nonprofit insurance co-ops have shut down in the past couple of years.

Dwindling exchange participation from insurers is becoming a concern because competition is supposed to help control insurance price increases, and many carriers have already announced plans to seek price hikes of about 10 percent or more for 2017.

Urban markets or places with higher populations should still have plenty of health insurance choices on their exchanges for 2017, said Sabrina Corlette, a research professor with Georgetown University’s Health Policy Institute. But that might not be the case in many rural markets.

The rural markets can be less attractive to insurers because there are fewer customers over which an insurer can spread costs, and hospitals and other health care providers can build dominating market positions, making them formidable negotiating foes over rates.

Health insurers have been finalizing their exchange plans over the past several weeks, ahead of the Nov. 1 start of enrollment for 2017 coverage.

Additional material from The Associated Press and The Washington Post.


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