Health Insurance

Aetna made a profit in Pennsylvania last year, but will exit Obamacare market there

Aetna: Obamacare move not related to DOJ lawsuit

Even a nice profit last year wasn't enough to keep this big insurer selling Obamacare in Pennsylvania.

Major health insurer Aetna included Pennsylvania on its list of 11 states where it will cease to sell Obamacare plans next year, despite the fact that it booked a decent profit on such plans in the Keystone State in 2015, records show.

Aetna collected more than $71 million in premiums, according to a recent rate filing request.

Before taxes, the company made $13.6 million from those plans, according to that same filing. That pre-tax profit represents the difference between the premiums it received, and what it paid out in claims — $52 million — and the $5.8 million it incurred in administrative expenses, Aetna said in its filing.

In 2017, Aetna projected it would book a 3.9 percent profit if its steep average premium rates were approved by the state Insurance Department for more than 47,000 customers. The insurer also projected that it would pay out slightly less than 80 percent of the premiums it received toward medical claims by customers.

"We don't discuss our performance on a state level," Aetna spokesman T.J. Crawford told CNBC after the insurer's profitable Pennsylvania picture was first highlighted by the website Balloon Juice on Wednesday.

Crawford declined to say whether Aetna's plans were profitable in Pennsylvania this year, or identify which, if any, other states where the insurer is exiting were profitable in 2015 and for the current year.

He did note, however, that "past results are not indicative of future performance. Crawford also pointed out that 55 percent of Aetna's Obamacare customers in 2016 are new customers, and that as a group they tend to have higher medical costs.

On Wednesday, the Huffington Post broke the news that Aetna in July had threatened in a letter that it would shrink the number of states where it sells Obamacare plans next year if the U.S. Department of Justice sought to block the insurer's planned merger with Humana.

"Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint," Aetna CEO Mark Bertolini wrote the DOJ's antitrust division, in the letter that was obtained by the Huffington Post.

Obamacare exchanges are where most Affordable Care Act plans are sold by insurers, and the only places where customers can received federal financial aid to help pay premiums if they have low or moderate incomes.

The DOJ ended up filing suit to block that merger with Humana.

On Monday, Aetna said it will discontinue Obamacare sales in 11 of the 15 states where it has been offering such plans. It will only sell individual plans in Delaware, Iowa, Nebraska and Virginia next year.

Bertolini said that the $200 million in second-quarter pre-tax losses that Aetna recently booked on its Obamacare plan sales led to the decision to dramatically scale back the business. That loss represents nearly half of the $430 million in losses Aetna has experienced in the ACA individual plan market since 2014.

Aetna's pullback followed similar moves by UnitedHealth Group and Humana to sharply shrink their Obamacare footprint.

Aetna said Wednesday that it was not threatening to quit Obamacare in its letter to the DOJ, and also claims that its decision is not in retaliation for the DOJ blocking the decision.

The company said that "significant deterioration" of financial results of Obamacare plans in the second quarter led to the decision. Crawford, the insurer's spokesman, noted that as recently as the first quarter of this year, Aetna had been saying that it might break even on its individual health plans.

Aetna, before its decision to bow out of Pennsylvania and 10 other states, was requesting average rate hikes of 17.2 percent in Pennsylvania for 2017. The actual proposed rate increases range from 2.6 percent to 30.4 percent.

In its rate filing request, Aetna cited the fact that "medical costs are going up and we are changing our rates to reflect this increase."

"We expect medical costs to go up 9.9 percent excluding the effect of benefit or cost sharing changes," Aetna said. "Medical costs go up for two reasons — providers raise their prices and members get more medical care."

The insurer also noted that an Obamacare program designed to offset the costs borne by insurers will end next year.

"The discontinuation of this program will increase premiums 5.7 percent," the insurer said. "Based on 2016 membership, claims experience for this market has been worse than anticipated. Part of the rate increase is needed to ensure that we can continue to offer coverage in this market."