Health Coverage Threatened by Insurers Pulling Out of Affordable Care Act

The Affordable Care Act is legislation designed to improve the quality and cost of American healthcare. Among the many reasons that the ACA exists is to stop discrimination against poor and chronically ill patients. Prior to the ACA, insurance companies could refuse to cover people who had serious pre-existing or sudden onset conditions. Those patients couldn’t get the level or quality of coverage they needed to improve their health and standard of living. The stated goal of the ACA is for everyone to receive coverage via low-cost plans through marketplace exchanges partially funded by the federal government or expanded state-run Medicaid without discrimination based on the type and duration of a patient’s illnesses or associated treatments.

Health Insurers Pulling Out of Affordable Care Act Marketplace

Health insurance companies are for-profit businesses. United Healthcare, Aetna, and Humana have decided to pull out of some or all states. They claim that they’re suffering too many financial losses through the exchanges. Earlier this year, UH’s leadership claimed that the company suffered $1 billion in related losses. Aetna recently claimed that it suffered $430 million in losses. Insurers state that the government’s patient-care cost estimates were too low because the previously uninsured are “sicker” and require more care than estimated, including high-cost “specialty” drugs. Yet Aetna wanted to merge with Humana and Cigna and used pullout from the exchanges as a threat. When the government refused the mergers, Aetna made good on the threat.

The healthcare exchanges provide coverage to over 11 million people. More than at least one million Americans will have limited coverage alternatives after the pullouts – especially in some rural regions and states. Many patients will have to turn to Medicaid or go without coverage. Americans still in exchange plans can expect extreme premium hikes in 2017 if insurers receive approval this year to make up losses through premiums.