On the Call: Aetna Chairman, CEO Mark Bertolini

The health care overhaul takes a major step toward expanding coverage to millions of people this fall, when insurance shoppers will start using online, state-run exchanges to compare and pick policies.

Many customers will be able to buy coverage that starts in 2014 with the help of income-based tax credits or subsidies. Also starting next year, health insurers will no longer be able to reject customers because they have a medical condition that existed before they applied for a policy.

These changes have prompted some to speculate that employers will start dumping the health insurance coverage they provide for workers once the exchanges are available. That coverage has been a growing cost burden for many businesses, but it also can be a key draw in attracting new employees and keeping them.

Goldman Sachs analyst Matthew Borsch asked Aetna officials about this possibility during a Thursday morning conference call to discuss the insurer's fourth-quarter. Aetna's earnings sank 49 percent, as medical costs climbed and it booked several one-time expenses. The insurer earned $190.1 million, or 56 cents per share, on $8.96 billion in revenue, not counting one-time items.

Aetna Chairman and CEO Mark Bertolini responded to Borsch.

QUESTION: Do you think some large and small employers may drop coverage heading into 2014 or will that be limited?

RESPONSE: On the large group side, we don't see a whole lot of activity about dropping coverage. What we will see are the emergence of private (insurance) exchanges, but that will be a slow start in 2014. In the small group market, we don't see a whole lot of impetus for small groups to drop coverage and push their people into the exchanges unless those employees are getting a lot of subsidy.

We're also seeing a lot of discussion around reducing hours on employees below 30 hours to avoid having to provide health care coverage at all.