Skip to main content

Aetna Inc.'s (AET) decision to exit the public healthcare exchanges in 11 out of the 15 states it's currently in could be more motivated by politics than business, according to analysts, especially since the insurer pulled out of at least two states—Pennsylvania and Arizona—that were expected to be profitable next year.

The Hartford, Conn.-based company announced on Aug. 15 that it will reduce its participation in the public health exchanges set up by the Affordable Care Act to 242 counties from 778, attributing the move to losses reported in the second quarter of 2016.

But on a second look, it seems that there was more to the move than that.

Aetna is embroiled in a legal battle with the Department of Justice over antitrust concerns about its $37 billion acquisition of Humana. Analysts expected Aetna to reduce its participation in the public exchanges as a way to ameliorate antitrust concerns the DoJ raises in the lawsuit. But critics, such as Sen. Elizabeth Warren (D-Mass.), instead believe Aetna is using the pullback as a negotiating tool involving that lawsuit.

"Aetna says this change of tone about the Affordable Care Act has nothing to do with the merger, but some analysts have suggested that Aetna might 'use its future participation in the exchanges in bargaining over its purchase of Humana,'" Warren wrote in an Aug. 11 Facebook post.

The Wall Street Journal reported on Wednesday that the company warned DoJ officials in early July that it would immediately pull out of the health exchanges if the government sued to block the deal. Reuters subsequently cited a July 5 letter from CEO Mark Bertolini to the DoJ warning that the insurer would exit much of the individual Obamacare insurance market if the agency challenged the merger.

An examination of Arizona and Pennsylvania government records by The Deal, a unit of The Street, shows that Aetna is profitable in those states or expects to be, but data on the company's profits couldn't be immediately accessed for the other states it chose to exit, including Florida, Texas, South Carolina, North Carolina, Kentucky, Missouri, Georgia, Ohio and Illinois.

Scroll to Continue

TheStreet Recommends

Aetna has chosen to remain in Delaware, Iowa, Nebraska and Virginia.

According to a May 10 filing with the Pennsylvania Dept. of Insurance, Aetna made a $13.6 million profit in 2015 through its participation in the public health exchange there. It expects to rake in a 3.9% profit margin on public exchange premiums in the state in 2017.

In a May 6 filing with the Arizona Dept. of Insurance, Aetna  said it anticipated profits of $3.3 million, also a 3.9% profit margin, on premiums in 2017. In labandoning Arizona, Aetna will leave one county there with no healthcare provider available on the public exchange.

According to analyst Vishnu Lekraj of Morningstar Inc., the federal government seems to be at odds with itself when it comes to the decision to block the Aetna-Humana deal.

"Some of the ammunition the DoJ is using to try to block these deals is the very reason why the ACA was put into place," Lekraj said in phone interview. "The bigger these companies can become, the more efficient they can get and the more cost they can take out of the system."

He added, though, that it makes sense that Aetna may have pressured the DoJ to refrain from taking legal action against the company.

"As far as them warning the Justice Department, it makes sense," Lekraj said. "That's the reason these mergers made operational sense."

Aetna, which has a market cap of $41.15 billion, was trading at $120.15 per share, up 1% from market's open, on Wednesday morning. Company officials didn't return requests for comment.