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Aetna bows out of ACA exchange in Pa.

Aetna said this week that it is leaving the Affordable Care Act marketplace in Pennsylvania to help balance its financial losses from selling insurance plans on the exchange.

The Connecticut-based insurer will no longer sell individual health insurance plans through Pennsylvania’s ACA exchange, and coverage will not be available for 2017. Coverage for 2016 will not be affected, according to Aetna spokesperson Walt Cherniak.

Aetna will continue to offer health plans in the commonwealth outside of the exchange, Cherniak said.

Overall, Aetna is dropping out of ACA exchanges in 11 of the 15 states where it is currently participating in. The insurer said the exchanges are costing it too much money.

High costs from the ACA are driven by the fact that individuals who signed up for health plans through the marketplace were either previously uninsured or under-insured, and they have used their health insurance plans at higher rates than expected.

Aetna reported a pretax loss of $200 million in the second quarter of 2016. Since January 2014, it has notched pretax losses of more than $430 million due to individual health plan products in the exchange, according to Mark T. Bertolini, chairman and CEO of Aetna.

“As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision,” Bertolini said.

By reducing its individual health plan presence in the exchange, Aetna’s participation will drop from 778 to 242 counties across the U.S. It will remain on exchanges in Delaware, Iowa, Nebraska and Virginia.

Aetna is one of several insurers to reduce participation in the exchanges.

Minnesota-based UnitedHealth has left the exchanges, while other insurers across the U.S. are requesting to raise premiums on individual health plans to help cover costs. The average requested is for an increase of about 22.5 percent.

In Pennsylvania, the average is 23.6 percent, according to the Pennsylvania Insurance Department, which recently held a public hearing to address the significant premium increases sought by local insurers.

Only about 5 percent of people with health insurance in Pennsylvania are covered under individual health plans through the ACA, but while they are a small slice of people with insurance, they are costing insurance companies millions of dollars.

Lenay Ruhl

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