Five Democratic senators are demanding that Aetna explain how its abrupt decision to leave multiple Affordable Care Act exchanges, after previously declaring its intent to expand its presence, can be justified — other than by the U.S. Department of Justice’s challenge to its proposed merger with Humana.

The Huffington Post reports a letter sent to Bill Bertolini, Aetna’s chief executive officer, from Sens. Bernie Sanders of Vermont, Elizabeth Warren of Masschusetts, Ed Markey of Massachusetts, Sherrod Brown of Ohio and Bill Nelson of Florida, calls for an explanation by Sept. 15 for the company’s sudden turn against exchanges.

Of particular interest to the senators is the fact that Aetna warned in a letter prior to the Justice Department’s position on the merger that it would back off from its commitment to the ACA exchanges if its merger were blocked.

Prior to the Justice Department's action regarding the proposed Humana merger, Aetna had said that its presence on 15 exchanges was sufficiently successful that it actually planned to increase its participation and expand into additional markets. It also represented its presence on the exchanges as a positive factor for its business, even in investor calls, and never characterized the merger as critical to its ability to remain on the exchanges.

Once the Justice Department voiced its objection to the merger, however, Aetna instead announced its intent to withdraw from 11 of those 15 markets in which it participated, rather than expanding to 20 as it had previously intended.

The about-face, the senators say, is all the more remarkable not only because of the company’s previous bullish stance on the exchanges but also because of provisions of the proposed merger, and indeed the merger itself — now depicted as crucial to the company’s continuing presence in the exchanges.

The senators wrote, “We are particularly troubled that Aetna’s decision to leave the ACA exchanges appears to have been motivated by the Justice Department’s decision to challenge Aetna’s proposed $37 billion merger with Humana — a deal that the Justice Department and many experts predicted would harm competition in the health insurance market and negatively impact the cost and quality of health care. Aetna could not have been surprised at the concerns raised by regulators about this merger.”

In July, Bertolini wrote to the Justice Department: “[I]f the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses. Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint … [I]nstead of expanding to 20 states next year, we would reduce our presence to no more than 10 states … [I]t is very likely that we would need to leave the public exchange business entirely and plan for additional business efficiencies should our deal ultimately be blocked.”

The senators characterize Bertolini’s letter to the Justice Department as “an effort to pressure the Justice Department into approving a merger that the department has alleged violates antitrust law and has the potential to significantly harm consumers all across the country.” The senators’ letter includes a list of questions for Bertolini to answer by Sept. 15.

In a response to the Huffington Post report about the senators’ letter, Aetna spokesman T.J. Crawford was quoted saying in part, “Singling Aetna out may be politically convenient during election season, but this letter ignores realities and takes the focus away from needed reforms.”

Instant Insights /

Democratic senators challenge Aetna on exchange exit

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