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Radar On Market Access: Aetna Plans to Return to ACA Exchanges

Posted by Leslie Small on Feb 23, 2021

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Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing attractiveness of the individual insurance market for carriers. They also indicate that the trend is expected to continue, AIS Health reported.

"After careful consideration, we have decided to reenter the individual public exchange market as of January 1, 2022," newly minted CEO Karen Lynch said during CVS's fourth-quarter earnings call. "As the ACA has evolved, there is evidence of market stabilization and remedies to earlier issues," Lynch added.

Lynch indicated in an interview with The Wall Street Journal that Aetna will likely enter markets where it has (or might have) Medicaid business and where some of CVS's 650 HealthHUB stores — which include expanded clinics, labs for health screening, space for wellness pursuits and other features — are located.

Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, says that it "makes a ton of sense" for CVS to leverage its retail and clinical assets as it plots a return to the individual marketplace.

"The good thing about that retail presence of those health care hubs is that they've really developed those businesses, in part, to serve people that aren't covered because they're kind of a low-cost retail experience," Hempstead says.

In general, Hempstead says she "really wasn't surprised" that Aetna plans to get back into the ACA exchanges, "because especially this year, we've seen so much return to the market from some of the companies that left."

Chris Sloan, an associate principal at Avalere Health, points out that health insurers have "learned a lot" since the implementation of the exchanges. And with premiums stabilizing, carriers understanding more about the exchange population and an administration that has made clear its support of the ACA, insurers are seeing "the writing on the wall [that] this market is going to grow," according to Sloan.

Meanwhile, the Biden administration's recent moves regarding the ACA also could make the market more attractive for insurers by drawing in more customers. Democrats in the House are currently considering a COVID-19 economic relief package that would fully subsidize benchmark-plan premiums for some lower-income enrollees and cap marketplace premium subsidies at 8.5% of enrollees' income.
 

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Topics: Industry Trends, Data & Analytics, Payer