• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

  • About Us
  • Lexicon
  • Contact Us
  • Our Store
  • ↑
  • ↓
  • ←
  • →

Balloon Juice

Come for the politics, stay for the snark.

It’s easy to sit in safety and prescribe what other people should be doing.

You can’t love your country only when you win.

Ah, the different things are different argument.

I didn’t have alien invasion on my 2023 BINGO card.

The poor and middle-class pay taxes, the rich pay accountants, the wealthy pay politicians.

Our job is not to persuade republicans but to defeat them.

Battle won, war still ongoing.

The cruelty is the point; the law be damned.

Some judge needs to shut this circus down soon.

When do the post office & the dmv weigh in on the wuhan virus?

Only Democrats have agency, apparently.

I’m sure you banged some questionable people yourself.

if you can’t see it, then you are useless in the fight to stop it.

Balloon Juice has never been a refuge for the linguistically delicate.

Republicans don’t want a speaker to lead them; they want a hostage.

The GOP is a fucking disgrace.

Everybody saw this coming.

I’d hate to be the candidate who lost to this guy.

You don’t get to peddle hatred on saturday and offer condolences on sunday.

A sufficient plurality of insane, greedy people can tank any democratic system ever devised, apparently.

Tick tock motherfuckers!

Following reporting rules is only for the little people, apparently.

Something needs to be done about our bogus SCOTUS.

When I decide to be condescending, you won’t have to dream up a fantasy about it.

Mobile Menu

  • Winnable House Races
  • Donate with Venmo, Zelle & PayPal
  • Site Feedback
  • War in Ukraine
  • Submit Photos to On the Road
  • Politics
  • On The Road
  • Open Threads
  • Topics
  • Balloon Juice 2023 Pet Calendar (coming soon)
  • COVID-19 Coronavirus
  • Authors
  • About Us
  • Contact Us
  • Lexicon
  • Our Store
  • Politics
  • Open Threads
  • War in Ukraine
  • Garden Chats
  • On The Road
  • 2021-22 Fundraising!
You are here: Home / Anderson On Health Insurance / Aetna, cynicism and Pennsylvania

Aetna, cynicism and Pennsylvania

by David Anderson|  August 17, 20167:48 am| 58 Comments

This post is in: Anderson On Health Insurance, Because of wow., Election 2016, Free Markets Solve Everything

FacebookTweetEmail

Jonathan Cohn reports on report on Aetna’s strategy on linking Exchange participation and the rapid approval of their merger.

the move also was directly related to a Department of Justice decision to block the insurer’s potentially lucrative merger with Humana, according to a letter from Aetna’s CEO obtained by The Huffington Post.

Aetna Letter

TLDR: Nice exchanges there, be a pity if anything happened.

One of the states Aetna pulled out of is Pennsylvania. This is odd as a friend of the blog pointed out to me offline. Below is Aetna’s rate application memo for the individual market in Pennsylvania. You should look closely at the highlighted segment.

Aetna

Aetna was profitable in 2015 in the individual market in Pennsylvania. It is projecting to be profitable in 2017. The filing memo was drafted in late May and submitted to the Pennsylvania regulators in early June. Conditions have not changed enough to make Pennsylvania a money loser in under two months.

My wee bit of cynicism bears fruit. Aetna is trying to logroll an anti-competetive merger with on-Exchange political consequences. If it works for Aetna/Humana it burns a bridge to get the merger, and if it fails, it puts Aetna on the shitlist of any Democratic administration. That is a very interesting strategy when it is highly likely that there will be another Democratic administration.

UPDATE 1: Here is the relevant chunk of the 2016 Aetna filing memo for Pennsylvania.

Aetna 2016 filing memo

So in all years Aetna’s individual market operations in Pennsylvania were either profitable or projected to be profitable. Something stinks worse than a wrestling team’s locker room after two-a-days.

FacebookTweetEmail
Previous Post: « Wednesday Morning Open Thread: GOTV (and Run Out the Clock)
Next Post: Louisiana Flooding and Donation Information REPOST and UPDATE »

Reader Interactions

58Comments

  1. 1.

    RSR

    August 17, 2016 at 7:50 am

    >>TLDR: Nice exchanges there, be a pity if anything happened.

    haha, I was just about to tweet almost these exact words to you. Was making a pot of coffee when I saw the new post.

  2. 2.

    Baud

    August 17, 2016 at 7:51 am

    Nice find. Thanks, Richard.

  3. 3.

    amk

    August 17, 2016 at 8:14 am

    So, no antitrust law suits then?

  4. 4.

    MomSense

    August 17, 2016 at 8:20 am

    You’re spidey sense is uncanny. Now how do we get the “news” media to pick this up?

  5. 5.

    raven

    August 17, 2016 at 8:22 am

    @MomSense: That’s where I read about it first.

  6. 6.

    Richard Mayhew

    August 17, 2016 at 8:25 am

    @MomSense: I’ve sent this out to my health policy wonk contacts — it is getting picked up.

  7. 7.

    Anya

    August 17, 2016 at 8:25 am

    “Tom Daschle is a lobbyist for Aetna. This proves both parties are corrupt.” A BernieorBuster

  8. 8.

    Matt McIrvin

    August 17, 2016 at 8:28 am

    They might have gambled that they could make there not be another Democratic administration.

  9. 9.

    Baud

    August 17, 2016 at 8:32 am

    @MomSense: Just saw a tweet from the WSJ. Story is getting play.

  10. 10.

    nonynony

    August 17, 2016 at 8:48 am

    @Matt McIrvin:

    They might have gambled that they could make there not be another Democratic administration.

    I think that would be stupid.

    I suspect that it’s more that they didn’t think anyone would notice what they were doing because of the Trump Shitshow.

  11. 11.

    David Fud

    August 17, 2016 at 8:51 am

    These guys want their merger related hookers and blow, or they are taking their ball and going home. $14MM is chump change. Loot or bust.

    Seems to me they need to talk to their statisticians about their high risk strategy. Doesn’t seem like the brightest thing I have seen done, though apparently clever and wise diverge widely in the executive suite.

  12. 12.

    MomSense

    August 17, 2016 at 8:51 am

    Wow. Is our journalists learning?

  13. 13.

    I'mNotSureWhoIWantToBeYet

    August 17, 2016 at 8:52 am

    I like that quoted paragraph which basically says:

    We want to get bigger (to increase our monopoly rents and so that management can get more hookers and blow). The DOJ might not let us, so, because it will cost us money if we don’t succeed, we’ll pay for it by taking money out of our soon to be profitable business (that helps people, that is our core business) to pay the lawyers and the other party’s lawyers and management (so that they can get more hookers and blow). And we’ll explicitly tie the cutbacks to the DOJ so that we can’t be blamed for it. And at the end of the year we’ll collect our big bonuses (so that we can get more hookers and blow) by arguing that we’re becoming more efficient! And we’ll pave the way for a weaker Obamacare system that will make mergers easier with fewer restrictions in the future!! Genius!!1

    Heads they win big, tails they think they win. And they think they win in the long run because they think the “bad publicity” about cutbacks on the Exchanges is somehow going to hurt antitrust enforcement.

    The Aetna board should fire the CEO, and they should rescind the cuts. Will they? Doubtful, unless this really blows up in the next few weeks… Maybe Gucicfer 2.0 has something on them that he’s just waiting to release? :-/

    Cheers,
    Scott.

  14. 14.

    MobiusKlein

    August 17, 2016 at 9:06 am

    Anecdotal bit here: on if my college friends just now was complaining about Aetna declining coverage of basic woman’s heath coverage, and networks so narrow she could not find a provider.

    This is in San Jose ca, so there are plenty of places to go.

    Seems like Aetna is shitty in a number of ways

  15. 15.

    El Caganer

    August 17, 2016 at 9:18 am

    I just moved to Florida from Pennsylvania, and my Medicare supplement is with Aetna. Am I screwed?

  16. 16.

    Keith

    August 17, 2016 at 9:19 am

    So in ’14 they achieved 10.5% gross profit, 5.7(7)% after PA state and Fed, in ’15 they achieved 19% gross profit, 10.4(8)% after taxes.

    Unless their fees are massive, which they might be, it seems they have not got anything financial to gripe about – they were aiming for 3.9% after taxes and fees.

  17. 17.

    jon

    August 17, 2016 at 9:21 am

    And here’s a problem that hasn’t popped up anywhere yet: Pinal County, Arizona has no insurer on the exchanges. None. Of all the rural areas in this country, I wouldn’t have picked that one as the place this would first happen. And it certainly won’t be the last.

  18. 18.

    satby

    August 17, 2016 at 9:21 am

    @MobiusKlein: Aetna was my last employer insurance, and the worst I ever had. And rates went up and coverage declined every single year I had it too. I hope the DOJ or whoever has power throws the book at them and fines them almost into oblivion.

  19. 19.

    WereBear

    August 17, 2016 at 9:43 am

    @I’mNotSureWhoIWantToBeYet: To which I would add, that the actual work is done by their poorly paid drones — they simply plan how to get more hookers & blow.

    I have yet to talk to a person in an insurance company who is not simply front line troops. And we all know how expendable those are!

  20. 20.

    nonynony

    August 17, 2016 at 9:45 am

    @MobiusKlein: Aetna is actually the worst insurance company I’ve ever had to deal with. I only had them as supplemental because they were my wife’s employer’s choice but when they finally dropped them and she switched over to another provider suddenly all of the problems that they kept blaming on our doctor’s office were gone. Not a single denial that should have been paid being blamed on a “coding error” from the doctor’s office.

    In my experience the only company that was worse to deal with than Aetna was the old SBC before they became AT&T again. Even Time-Warner was easier to deal with. (Full disclosure – I’ve never had to deal with Comcast – they could perhaps be worse).

  21. 21.

    MomSense

    August 17, 2016 at 9:48 am

    @WereBear:

    Just caught your discussion of dealing with treatment for rare conditions. Mine isn’t all that rare but it can be expensive. The Superintendent of the Bureau of Insurance (insurance regulator) in my state was very helpful to me when I needed some back up in dealing with my insurance company.

  22. 22.

    Julian

    August 17, 2016 at 9:51 am

    Hi Richard, I don’t disagree with the overall conclusion of this article but it looks like the rate filing was posted before the risk adjustment payments were finalized. Maybe I’m missing something but it looks like the entity in question had a large risk adjustment outflow which would completely change the actual economics.

    https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/Downloads/June-30-2016-RA-and-RI-Summary-Report-5CR-063016.pdf

  23. 23.

    rikyrah

    August 17, 2016 at 9:54 am

    I don’t get my way, so I’m picking up my marbles and going home?

    really?

    seriously?

  24. 24.

    nonynony

    August 17, 2016 at 10:02 am

    @rikyrah: This feels less like a tantrum and more like a “pay me what I want or I burn the shop down”.

  25. 25.

    Richard Mayhew

    August 17, 2016 at 10:08 am

    @El Caganer: unlikely to be screwed

  26. 26.

    J R in WV

    August 17, 2016 at 10:10 am

    Insurance companies in the medical field make their money by acting as barriers to patients who need health care. They take money that should be funding the treatment of ordinary, or rare or expensive health problems, and KEEP IT.

    That’s their profit margin. Not only the hookers and blow funds, but all of it. They are immoral scum, especially Aetna, and I suspect United, because of their history with Medicare Fraud in the billions of dollars.

    So, yes, I too hope the DoJ fines Aetna a monumental amount of money for being liars about their profit margins and willingness to shaft multiple states full of patients in an effort to further monopolize their provision of health care barriers in the name of profits.

  27. 27.

    Richard Mayhew

    August 17, 2016 at 10:22 am

    @J R in WV: On what grounds does the DOJ have to act? This is an “internal business decision” of a company operating in a capitalistic system. IANAL, but I have a hard time seeing a case and a cause here. Being a douchebag extraordinaire is not a tortable offense in and of itself.

  28. 28.

    schrodinger's cat

    August 17, 2016 at 10:23 am

    Aetna was my provider when I was in school, my experiences were by and large positive but apart from a twisted ankle and my annual checkup I didn’t really use my insurance.

  29. 29.

    Chris

    August 17, 2016 at 10:36 am

    @rikyrah:

    Well, yeah. I’m pretty sure that in the thirty six years since Reagan’s election, many and possibly most of the country’s corporate overlords have become convinced that they are in fact entitled to anything they want and that if they don’t get it they should totally take their ball and go home. And why wouldn’t they be? The country’s overrun with sycophants – in the media, in think tanks, in politics – who rush to tell them exactly that.

  30. 30.

    Ed St Clair

    August 17, 2016 at 11:12 am

    The most unrealistic part of the entire article is the statement “That is a very interesting strategy when it is highly likely that there will be another Democratic administration.” Puhleeze!! Otherwise, very insightful…a true revelation of the mindset of corporate America.

  31. 31.

    quakerinabasement

    August 17, 2016 at 11:16 am

    In Aetna’s PA statement, the company projects that admin expenses will nearly double as a percentage of premiums between 2016 and 2017. WT everlovin’ F?

  32. 32.

    brendancalling

    August 17, 2016 at 11:23 am

    “Something stinks worse than a wrestling team’s locker room after two-a-days.”
    Maybe so, but it doesn’t change the fact that SE PA now has one choice for exchange plans. And when you only have one choice, that’s not a choice.

  33. 33.

    lurker dean

    August 17, 2016 at 11:28 am

    i tweeted a link to this post to the phila inquirer reporter who wrote a story about aetna withdrawing from PA, let’s see if he follows up…

  34. 34.

    Villago Delenda Est

    August 17, 2016 at 11:48 am

    @J R in WV: They.are.parasites.

  35. 35.

    Villago Delenda Est

    August 17, 2016 at 11:49 am

    @quakerinabasement: Their blow dealer wants more, and the hookers want more.

  36. 36.

    Villago Delenda Est

    August 17, 2016 at 11:50 am

    @schrodinger’s cat: You were their ideal customer…one who paid in, and didn’t ask for much back.

  37. 37.

    martian

    August 17, 2016 at 11:53 am

    Fucking Aetna. My surgical oncologist said they were the worst. He said he had to keep a person employed full time just to keep following up on claims and paperwork mainly with them, though they were not the only culprits. It was his opinion that they were counting on a certain percentage of people just giving up or forgetting to keep following up, and then they got to keep the money. Being a shitty company was part of their business plan, a feature, not a bug..

  38. 38.

    John M. Burt

    August 17, 2016 at 12:04 pm

    The wee bit of cynicism bears bitterly clinging fruit….

  39. 39.

    RaflW

    August 17, 2016 at 12:14 pm

    At the time this strategy was being drafted, the CW was that Pennsylvania would be in play for Trump. A major player pulling out of the PA Exchange looks bad for ACA, and the Repubs want things to look bad for ACA.

    Richard, do you know if anyone has done a red/blue analysis of states where insurers are pulling up stakes?

    ETA (and related to @jon‘s comment): I was talking with my partner last night about the broader issue of insurers leaving markets or jacking rates 40% that we wondered if this will get the ball rolling for a public option. Of course we’d need a tsunami election to have the politics even remotely in place for that in the short term, but it just strikes me that insurers are playing a game here that they could lose.

  40. 40.

    Richard Mayhew

    August 17, 2016 at 12:16 pm

    @brendancalling: no, but it could significantly lower post-subsidy premium costs

  41. 41.

    John M. Burt

    August 17, 2016 at 12:22 pm

    @martian: I am willing to believe that Aetna is the worst offender, but every medical office has to keep a person on staff to fight with every insurance company. Naturally, if you’re an independent operator such as a massage therapist, you are well-and-truly’d.
    I once signed on for a year with an outfit which promised me increased business if I agreed to offer a steep discount to policyholders, part of which they would reimburse me for.
    I offered the discount, and business increased. Guess what didn’t happen? Hint: it won’t cost you a thousand dollars to find out.

  42. 42.

    Raven Onthill

    August 17, 2016 at 1:34 pm

    It is as I said. A solid opportunity for a solid profit is not enough for these guys. They’ve gotta have their monopoly.

    At this rate, a public option is going to be the only way to keep the system functional in some states. Better hope that Hillary Clinton really does have those brass balls conservatives keep talking about.

  43. 43.

    ding

    August 17, 2016 at 1:45 pm

    Pennsylvania has 67 counties – why aren’t all of them listed? Are the non-listed countes staying in the ACA?

  44. 44.

    joel hanes

    August 17, 2016 at 1:51 pm

    When I worked for [a large software company whose name you’d instantly recognize] Aetna was our insurance administration (the company was big enough to self-insure). Aetna repeatedly declined to pay for care explicitly covered in the contract, and I had to get the company benefits managers to intervene at least once a year for three years in a row. In the fourth year, my company dumped them for someone else.

    Fuck them.

  45. 45.

    Mnemosyne

    August 17, 2016 at 2:08 pm

    Ah, Aetna. The company that refused to cover my overnight admission to the hospital for possible appendicitis because my PCP was on vacation and I saw someone else IN THE SAME OFFICE.

    The hospital was surprisingly nice when I explained why I wasn’t going to pay my part of the bill until Aetna paid theirs, which they finally did …

    Four years later.

  46. 46.

    Arclite

    August 17, 2016 at 2:11 pm

    “That’s a nice exchange you got there. It would be a shame if anything were to happen to it.”

  47. 47.

    martian

    August 17, 2016 at 2:44 pm

    @John M. Burt: Oh, I agree that all of them are doing it, but Aetna seems in a rapacious class of it’s own. I’m sorry you got bitten like that. I used to think the horror stories were just the result of bureaucratic inefficiencies, but I don’t anymore. The system is functioning as intended, squeezing every vulnerable point for profit.

  48. 48.

    Dave

    August 17, 2016 at 3:56 pm

    @ding: The counties listed are the only ones in which Aetna does business on the ACA website. Aetna doesn’t offer plans in the rest of PA, as the ACA doesn’t require that insurance companies offering plans in a particular state service the entire state (yet another flaw introduced by Republicans and Conservadems so as to allow private corporations to cherry-pick the most profitable customers, #thankslieberman #thanksbaucus.)

  49. 49.

    Bill Arnold

    August 17, 2016 at 5:38 pm

    In case you didn’t know, also linked and praised and described by Kevin Drum:
    Why Is Aetna Pulling Out of Nice, Profitable Pennsylvania?

  50. 50.

    ding

    August 17, 2016 at 10:43 pm

    @Dave:
    thank-you

  51. 51.

    Tim Shea

    August 18, 2016 at 11:26 am

    @Anya: Hey , show a little sympathy. It’s really tough finding commensurate income once you’ve left a job where little work was needed.

Comments are closed.

Trackbacks

  1. They actually made money selling Obamacare. They're still leaving. | Vantage Markets says:
    August 17, 2016 at 4:37 pm

    […] CNBC after the insurer’s profitable Pennsylvania picture was first highlighted by the website Balloon Juice on […]

  2. Help wanted: A Congress capable of fixing things | Jay Bookman says:
    August 18, 2016 at 6:46 am

    […] Pennsylvania is one of the markets that Aetna has abandoned, claiming it can’t make a profit. Yet by its own numbers, it DOES make a profit in […]

  3. Why Is Aetna Pulling Out of Nice, Profitable Pennsylvania? - GreenEnergy4.us says:
    August 18, 2016 at 11:24 am

    […] Last night I linked to a letter from Aetna to the Department of Justice explaining what they would do if their merger with Humana wasn’t approved. The answer, basically, was that they’d pull out of a bunch of Obamacare exchanges. As insurance pro Richard Mayhew puts it: […]

  4. Why Is Aetna Pulling Out of Nice, Profitable Pennsylvania? | Later On says:
    August 18, 2016 at 11:59 am

    […] Last night I linked to a letter from Aetna to the Department of Justice explaining what they would do if their merger with Humana wasn’t approved. The answer, basically, was that they’d pull out of a bunch of Obamacare exchanges. As insurance pro Richard Mayhew puts it: […]

  5. Aetna Made A Profit In Pennsylvania Last Year, But Will Exit Obamacare Market There | Wealthy Doctor says:
    August 18, 2016 at 2:32 pm

    […] CNBC after the insurer’s profitable Pennsylvania picture was first highlighted by the website Balloon Juice on […]

  6. Aetna’s and Bertolini’s pants catch fire | ARTS & FARCES internet says:
    August 20, 2016 at 7:30 pm

    […] cites Richard Mayhew writing for Balloon Juice and Charles Gaba writing for ACASignups reporting that Aetna is profitable in the Pennsylvania ACA […]

  7. Why did Aetna decide to exit a state where it was making money? | D Gary Grady says:
    August 25, 2016 at 9:07 pm

    […] money. Curiously, though, one of those states is Pennsylvania, where (according to Aetna itself, as Richard Mayhew pointed out) it made a healthy profit there in the individual market for at least the past two years, and it […]

Primary Sidebar

Recent Comments

  • James E Powell on Wednesday Morning Open Thread: Politics The GOP, Hollywood for Ugly People (May 31, 2023 @ 11:40am)
  • Barry on Honey, I’m Home Wednesday Morning Open Thread (May 31, 2023 @ 11:38am)
  • RaflW on Wednesday Morning Open Thread: Politics The GOP, Hollywood for Ugly People (May 31, 2023 @ 11:36am)
  • Reboot on Wednesday Morning Open Thread: Politics The GOP, Hollywood for Ugly People (May 31, 2023 @ 11:35am)
  • Old School on Wednesday Morning Open Thread: Politics The GOP, Hollywood for Ugly People (May 31, 2023 @ 11:34am)

Balloon Juice Meetups!

All Meetups
Seattle Meetup on Sat 5/13 at 5pm!

🎈Keep Balloon Juice Ad Free

Become a Balloon Juice Patreon
Donate with Venmo, Zelle or PayPal

Fundraising 2023-24

Wis*Dems Supreme Court + SD-8

Balloon Juice Posts

View by Topic
View by Author
View by Month & Year
View by Past Author

Featuring

Medium Cool
Artists in Our Midst
Authors in Our Midst
We All Need A Little Kindness
Classified Documents: A Primer
State & Local Elections Discussion

Calling All Jackals

Site Feedback
Nominate a Rotating Tag
Submit Photos to On the Road
Balloon Juice Mailing List Signup
Balloon Juice Anniversary (All Links)
Balloon Juice Anniversary (All Posts)

Twitter / Spoutible

Balloon Juice (Spoutible)
WaterGirl (Spoutible)
TaMara (Spoutible)
John Cole
DougJ (aka NYT Pitchbot)
Betty Cracker
Tom Levenson
TaMara
David Anderson
Major Major Major Major
ActualCitizensUnited

Join the Fight!

Join the Fight Signup Form
All Join the Fight Posts

Balloon Juice Events

5/14  The Apocalypse
5/20  Home Away from Home
5/29  We’re Back, Baby
7/21  Merging!

Balloon Juice for Ukraine

Donate

Site Footer

Come for the politics, stay for the snark.

  • Facebook
  • RSS
  • Twitter
  • YouTube
  • Comment Policy
  • Our Authors
  • Blogroll
  • Our Artists
  • Privacy Policy

Copyright © 2023 Dev Balloon Juice · All Rights Reserved · Powered by BizBudding Inc

Share this ArticleLike this article? Email it to a friend!

Email sent!