There’s a simple fix for Obamacare’s current woes: the public option

http://www.vox.com/2016/8/18/12520820/public-option-health-care-obamacare

THE REALITY IS THAT COMPETITION AMONG PRIVATE INSURERS HAS NEVER LIVED UP TO THE RHETORIC PUT FORTH BY THE INDUSTRY OR FREE MARKET FUNDAMENTALISTS

This week, Aetna announced it would stop selling insurance plans in all but four Obamacare exchanges, the state-run markets set up under the 2010 Affordable Care Act. Aetna, which now covers more than 800,000 people in 15 exchanges, said it had been hemorrhaging money on the plans. (A fight with the government over an acquisition of the insurance company Humana may have played a role, too.)

Aetna’s exit, following similar departures by UnitedHealth and Humana, means that a growing number of US counties — 20 to 25 percent, according to the Kaiser Family Foundation — now have only a single private insurer offering coverage on the exchanges, a development that essentially eliminates consumer choice. One county in Arizona now has no insurers. Even before Aetna’s decision, more than half of state exchanges had four or fewer insurers, with DC, Vermont, Connecticut, and Rhode Island having only two.

It’s enough to make a frazzled health care consumer in one of those feeble markets wish there were another option — perhaps even (dare one say it?) a public option. Does the phrase ring a bell? That’s the health care policy that some policymakers pushed to include in the 2010 law.

Obamacare CEO Kevin Counihan counterstrikes after Aetna’s ACA exit

http://www.fiercehealthcare.com/payer/obamacare-ceo-kevin-counihan-counterstrikes-aetna-s-aca-exit

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In the aftermath of Aetna’s ACA exchange exit, which leaves places like Pinal County, Arizona, with no insurers scheduled to offer plans in 2017, Obamacare CEO Kevin Counihan says HHS has already revved up its efforts to recruit insurers to fill in the gaps, according to an interview with Politico.

Insurers, including most recently the Dallas-based insurer Scott & White Health Plan, say sicker, more expensive populations mean they’re losing money on government-created marketplaces. Aetna, Scott & White, UnitedHealth and Humana have all said they can’t afford to keep offering the plans.

This week, Aetna dropped out of 68 percent of the exchanges in which it was operating.

But the insurance market–a market based in risk, after all–will always be dynamic. That was the case even before healthcare reform. “This is the nature of the industry,” Counihan toldPolitico.

According to University of Chicago economist Robert Kaestner, these exits are entirely normal.

“I don’t think it’s a particularly unusual situation where the firms are leaving the market,” Kaestner told Salon. “The fact that firms can leave and enter markets means the markets are, in fact, quite competitive.”

EpiPen Manufacturer Says It Will Help With Out-Of-Pocket Costs

http://www.npr.org/sections/health-shots/2016/08/24/491232665/latest-target-in-the-drug-price-wars-the-ubiquitous-epipen?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=33405785&_hsenc=p2ANqtz-8XZii4uOFohPHJzQb2tGya0B1V39hwW9G6vwptGGc5BvcM-YWZemfyDF8k4814h6RX0C21PHgcZ9Nz_LIAH_zmJW4gCw&_hsmi=33405785

The wholesale price of a single pen was about $47 in 2007, and it rose to $284 this summer, according to Richard Evans, a health care analyst at SSR. But consumers can no longer buy a single pen, so the retail price to fill a prescription today at Walgreens is about $633, according to GoodRX.

It’s the latest in a string of controversies over rising drug prices that have caught the attention of lawmakers on Capitol Hill.

The drug’s manufacturer, Mylan NV, responded to the criticism Thursday, announcing it will offer customers whose insurance doesn’t pay the full cost coupons for up to $300 off the injectors. But it’s unclear if that will be enough to tamp down the anger.

At least three senators have called for investigations into the price of the EpiPen, and Sens. Charles Grassley, R-Iowa, and Richard Blumenthal, D-Conn., have sent letters to Mylan demanding an explanation for the increase.

 

Aetna CEO’s $131 Million Parachute Biggest Among Health Targets

http://www.bloomberg.com/news/articles/2015-06-17/aetna-ceo-s-131-million-parachute-biggest-among-health-targets

 

Aetna Inc. CEO Mark Bertolini has the most to gain among top executives at the three U.S. health insurers seen as targets in a potential wave of industry consolidation. Bertolini could receive $131.3 million should he lose his job in a takeover, according to data compiled by Bloomberg. Cigna Corp. Chief Executive Officer David Cordani would get $58.7 million, while Humana Inc. CEO Bruce Broussard’s so-called golden parachute is valued at $26.1 million.

The five biggest publicly traded insurers are all eyeing potential combinations after a two-year lull in big managed-care deals. Anthem Inc. has explored a takeover of Cigna and Humana, and Aetna and Cigna have considered buying Humana, Bloomberg has reported. The Wall Street Journal has said UnitedHealth Group Inc. might be interested in Aetna or Cigna.

We “expect this merger frenzy will culminate in a ‘Big Three’ that is a more efficient industry landscape,” Ana Gupte, an analyst at Leerink Partners, said Tuesday. Humana is likely to be acquired by Aetna or Anthem for $200 to $225 a share, she wrote.

The change-in-control payouts are meant to keep investor interests in mind.

“These protections provide a certain level of comfort for executives to put aside their personal issues and think, ‘What’s in the best interest of shareholders?’” said Yonat Assayag, a partner at ClearBridge Compensation Group, an executive pay consulting firm. “The amounts may seem large, but the cost compared to the value that’s created for shareholders is usually a very small percentage.”

Healthcare Hypocrite of the Week: Aetna’s Mark Bertolini

http://medcitynews.com/2016/08/hypocrite-aetna-mark-bertolini/?utm_source=hs_email&utm_medium=email&utm_content=33097793&_hsenc=p2ANqtz-8tHuz1OyW0jad1rYHbmCrWm51PA21pdsKB9af25xlqpvHnWr2o1T0b7LutMzmXzy521UtBFmUcZw75t8pNJcQYSG5Uvw&_hsmi=33097793

Mark Bertolini

Mark Bertolini, CEO of Aetna

It’s only Thursday, but it’s probably safe to announce that the winner of Healthcare Hypocrite of the Week is Aetna Chairman and CEO Mark Bertolini. And it’s not because Elizabeth Holmes and Martin Shkreli have managed to stay out of the news for a while.

Despite calling the Affordable Care Act business a “good investment” as recently as April, Bertolini has decided to pull Aetna out of most of the public health insurance exchanges. Initially, he cited the ACA risk pools as being unsustainable — in other words, too many old people with chronic illnesses and not enough young and spry customers to mitigate the risk. But as it turns out his actions may have been prompted by a desire to get even when the insurer didn’t get its way on a business deal.

On Monday, Aetna announced that it was pulling out of public individual insurance exchanges in all but four states. For the 2017 plan year, the Hartford, Connecticut-based insurer will only participate in the exchanges in 252 counties in Delaware, Iowa, Nebraska and Virginia. The reason? The company said it lost $200 million on individual plans in the second quarter and $430 million since the Obamacare insurance mandate took effect in 2014.

Letter shows Aetna warned DOJ it would exit Obamacare markets if merger challenged

http://www.healthcarefinancenews.com/news/letter-shows-aetna-warned-doj-it-would-exit-obamacare-markets-if-merger-challenged?mkt_tok=eyJpIjoiTW1Jek1EWm1PRFpqWldZeCIsInQiOiJNUE5TM3FXaktDWTF6WFlreiszSFpHRjZBeENcL3ZCS1REN01UQzVvVG9pdGNsSmZnK1BwTlJNWHhzZGdGRzdTckRoS2VqT05tMGVXZTdDWjN5SmVxbW1sR09qRDNnaTBNbEpXY3M5cjZaaUE9In0%3D

Aetna CEO Mark Bertolini (file photo)

Aetna CEO Mark Bertolini

Aetna warned the Department of Justice in a July 5 letter that it would leave the public exchange market if the agency went forward and blocked its merger with Humana.

“Our analysis to date makes clear that if the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses,” Aetna CEO Mark Bertolini said in the letter. “Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint.”

The letter to Ryan M. Kantor, assistant chief for litigation in the Antitrust Division, was sent days before the DOJ’s injunction blocking Aetna’s $37 billion merger with Humana, and also Anthem’s planned $54 billion deal with Cigna.

This week, Aetna announced it was exiting the Obamacare-created exchange market in all but four states in 2017, a reduction of its current participation in 15 states.

However, Aetna left the exchange markets after seeing deteriorating numbers in its second quarter results, the insurer said in a request for comment today.

“That deterioration, and not the DOJ challenge to our Humana transaction, is ultimately what drove us to announce the narrowing of our public exchange presence for the 2017 plan year,” Aetna said.

Sutter Health to employers: Waive rights to sue or pay the price

http://www.healthcaredive.com/news/sutter-health-to-employers-waive-rights-to-sue-or-pay-the-price/424614/

 

Battle of the bulls: Aetna threatened ACA participation over Humana merger blockage

http://www.healthcaredive.com/news/battle-of-the-bulls-aetna-threatened-aca-participation-over-humana-merger/424640/

  • In July, Aetna sent a letter to the Justice Department insinuating it would leave the ACA market if its pending merger with Humana was blocked by the DOJ, The Huffington Post reported.
  • Aetna announced late Monday it was exiting nearly 70% of the ACA markets it participated in next year (parsing down 778 counties to 242).
  • On Monday, CEO Mark Bertolini cited losses in the millions as the reason for the decision. However, the July letter obtained by The Huffington Post implies the decision was more influenced by the Justice Department lawsuit.

26 latest healthcare industry lawsuits, settlements

http://www.beckershospitalreview.com/legal-regulatory-issues/26-latest-healthcare-industry-lawsuits-settlements-august15.html

 

In Battle Of Health Care Titans, Should Insurers Act Like Wal-Mart?

http://www.npr.org/sections/health-shots/2016/08/11/488891554/should-big-insurance-become-like-walmart-to-lower-health-costs

Who has the upper hand in health care prices?

In late July, the Justice Department sued to block both insurance mergers, arguing that competition is important to keep premiums down and that the deals “would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies.”

They also rejected the Wal-Mart argument, which is related to what economists call “monopsony,” a concentration of buying power.

Monopsony is the opposite of monopoly: Instead of using market dominance to raise prices for consumers, huge buyers force down prices from suppliers. Wal-Mart is often described as holding monopsony-like power.

But critics of the insurance deals say monopsony can go too far. If the buyer pushes prices too low, suppliers stop producing, making needed goods and services unavailable.

“As a result of the merger, Anthem likely would reduce the rates that … providers earn by providing medical care to their patients,” the Justice Department argued. “This reduction in reimbursement rates likely would lead to a reduction in consumers’ access to medical care.”