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Humana latest insurer to scale back ACA participation, dropping 1,200 counties

by Gail Kalinoski, Contributing Reporter | August 05, 2016
Business Affairs
Payor's ACA revenue will drop
over $2 billion in 2017
Add Humana to the growing list of health insurance companies cutting their participation in the subsidized individual plans offered under the Affordable Care Act next year.

Humana said it would only offer individual health insurance plans on the ACA exchanges in 156 counties in the United States in 2017, down from 1,351 this year, according to the St. Louis Post-Dispatch. The company, based in Louisville, Kentucky, also said it would sell coverage on four fewer exchanges next year, going from 15 this year to 11 in 2017. The newspaper reported Humana currently provides individual insurance coverage for about 500,000 through the exchanges.

Other insurers, like UnitedHealth Group and Anthem have also said recently they were having issues with plans sold on the exchanges, including facing higher than expected claims, and were cutting or reconsidering their participation. In November, United Health Group announced it could not sustain the losses it was experiencing from exchange plans and was cutting back on getting new clients through the exchanges and might completely leave the marketplace next year. The company insured about 550,000 people through the exchanges, but the CEO said during a conference call at that time, “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”

Meanwhile, Aetna, which is seeking to acquire Humana, also projected a loss for ACA coverage plans for 2016 and said it too is reconsidering its 2017 participation in the exchanges. Barron’s noted Aetna had previously considered adding five states next year for a total of 20 but has decided against that expansion. Aetna reported a second-quarter loss of approximately $200 million on exchange plans and expects it will lose more than $300 million for the entire year.

Because of the pending merger between Aetna and Humana, Humana did not have an earnings’ conference call, so more details were not available on its decision to scale back its so-called Obamacare coverage next year, though one official did allude to issues the insurer has had so far.

“We are pleased that our year-to-date financial results are demonstrating consistently strong operational execution across our core businesses, though challenges in our Individual Commercial business remain,” Humana CFO Brian Kane said in the second-quarter earnings news release.

The earnings report noted that the company expects revenue from ACA plans to drop from $3.4 billion this year to $750 million to $1 billion in 2017, according to Forbes.

While some insurers are cutting back exposure to the ACA exchanges in the future, The Wall Street Journal reports Cigna Corp. plans to expand into “a limited number” of new markets next year despite losses on its current exchange plans. Cigna, the smallest of the five major national health insurers, does not have much ACA enrollment presence at this time but thought the new markets could produce better results, according to the WSJ story. Cigna is also in the midst of a potential merger with Anthem.

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