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From Kaiser Health News:

Kaiser Health News Original Stories

1. Obamacare Marketplace Shakeout Rocks Arizona, Southeast

Fewer choices in 2017 health care plans await consumers in dozens of markets where Aetna, UnitedHealthcare and Humana are pulling out, but withdrawals may hit Arizona, the Carolinas, Georgia and parts of Florida hardest. (Phil Galewitz, 8/18)

6. Political Cartoon: 'Is That A Thing?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Is That A Thing?'" by Dave Coverly, Speed Bump.

Here's today's health policy haiku:


So much for the bill
Designed to shed light on costs.
A win for pharma?


If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law Issues And Implementation

7. Aetna Warned DOJ: Block Humana Merger And We'll Pull Out Of ACA Markets

A letter from Aetna's CEO reveals a clear threat to the Department of Justice that if it challenged Aetna's proposed merger with Humana it would need to take immediate action to "to mitigate public exchange and ACA small group losses."

The Wall Street Journal: Aetna Warned U.S. Before Exiting Health Exchanges
The public emergence of the bluntly worded letter, from Aetna’s Chief Executive Mark T. Bertolini, has led critics to question the motives behind the insurance company’s recently disclosed pullback from the insurance exchanges. It also has added a layer to a broader debate over the causes and cures for the red ink the exchanges are generating for insurers. (Wilde Mathews and Armour, 8/17)

Huffington Post: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger
The big health care news this week came from Aetna, which announced on Monday it was dramatically scaling back participation in the Affordable Care Act ― thereby reducing insurer competition and forcing customers scattered across 11 states to find different sources of coverage next year. ... 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. (Cohn and Young, 8/17)

Reuters: Aetna Warned It Would Cut Obamacare If Humana Deal Was Blocked
In the July 5 letter, Aetna Chief Executive Officer Mark Bertolini said it would have to cut back because it would be some time before the company recouped the investment it had made in this market over the past 2-1/2 years. "Our ability to withstand these losses is dependent on our achieving anticipated synergies in the Humana acquisition," Bertolini wrote. (Humer, 8/17)

The Washington Post: Aetna Warned It Would Drop Out Of Obamacare Exchanges If Its Merger Was Blocked
Rep. Frank Pallone Jr. (N.J.), ranking Democrat on the Energy and Commerce Committee, issued a statement Tuesday saying he was "troubled by reports this announcement could be in retaliation" to the Justice Department's decision. Earlier this month, after Aetna announced in an earnings call this month that it was reevaluating its participation in the exchanges, Sen. Elizabeth Warren (D-Mass.) wrote on Facebook: "The health of the American people should not be used as bargaining chips to force the government to bend to one giant company’s will." (Johnson, 8/17)

NPR: Aetna CEO To Justice Department: Block Our Deal And We'll Drop Out Of Obamacare
The change in tack for Aetna is also noteworthy because Bertolini was talking up the business potential of the exchanges as recently as April, when he said during a call with analysts and investors that the exchanges were "a good investment," despite the losses incurred. At the time, Bertolini said that Aetna was "committed to working constructively with the administration and lawmakers to find solutions that can improve this program, stabilize the risk pool, and expand product flexibility, all with the goal of creating a sustainable program that makes health care more affordable and accessible for all consumers." Now, the company appears to be taking its ball and going home. (Hensley, 8/17)

The Wall Street Journal: Aetna’s Healthy Perspective On Obamacare
The trend of health insurers pulling back from public exchanges raises concern for the future of the Affordable Care Act. It is far less of a worry for investors. Aetna announced plans earlier this week to withdraw from 11 of the 15 states in which the insurer currently offers public exchange plans to individuals. ... Regardless of motivation, Aetna has chosen to exit an unprofitable business. The company said it lost $200 million in pretax income from the exchange business in the second quarter and expects to lose more than $300 million this year. (Grant, 8/17)

8. Latest Setback Highlights ACA's Intrinsic Problem: It Incentivizes Insurers To Misprice Risk

Aetna's decision to leave all but a handful of states is just the latest move that highlights an issue with the economic stability of the law. By circumscribing insurers’ ability to underwrite risks, the Affordable Care Act distorts how insurance is priced. Meanwhile, the administration prepares for a new push to get people enrolled, but many say it's too little, too late.

The Wall Street Journal: The Unstable Economics In Obama’s Health Law
Barack Obama’s signature health-care law is struggling for one overriding reason: Selling mispriced insurance is a precarious business model. Aetna Inc. dealt the Affordable Care Act a severe setback by announcing Monday it would drastically reduce its participation in its insurance exchanges. Its reason: The company was attracting much sicker patients than expected. Indeed, all five of the largest national insurers say they are losing money on their ACA policies and three, including Aetna, are pulling back from the exchanges as a result. The problem isn’t technical or temporary; it’s intrinsic to how the law was written. (Ip, 8/17)

The New York Times: As Insurers Balk, U.S. Makes New Push To Boost Health Care Act
Facing high-profile withdrawals from online insurance exchanges and surging premiums, the Obama administration is preparing a major push to enroll new participants into public marketplaces under the Affordable Care Act. The administration is eyeing an advertising campaign featuring testimonials from newly insured consumers, as well as direct appeals to young people hit by tax penalties this year for failing to enroll. But as many insurers continue to lose money on the exchanges, they say the administration’s response is too late and too weak. (Pear and Abelson, 8/17)

Politico: Obamacare's CEO Talks Insurer Recruitment After Aetna's Pullback
Aetna's sudden decision to quit most of its Obamacare insurance markets was the latest mess in the health law's rockiest stretch in almost three years. It's Kevin Counihan's job to clean it up. Counihan, CEO of the federal insurance marketplace, told POLITICO's "Pulse Check" podcast that Aetna's flip-flop — the company announced Monday it will exit from 69 percent of counties it now serves through Obamacare, just three months after committing to stay and even expand — doesn't alter the administration's strategy. (Diamond, 8/18)

Los Angeles Times: Pullback From Obamacare By Aetna, Other Insurers Puts Pressure On Upcoming Enrollments
Recent decisions by giant health insurers to pull back from Obamacare exchanges across the country could make this fall’s enrollment period crucial to the program that has helped millions of people gain health coverage. “We won’t know until the next open enrollment, are we still moving forward or are we stalled or moving backward?” said Gary Claxton, director of the nonprofit research group Health Care Marketplace Project at Kaiser Family Foundation. “If the market grows, then I think many insurers will find a way to be part of it. “The next couple of months are a moment of truth,” he said. (sen and Sisson, 8/17)

In other news about the marketplaces —

Modern Healthcare: Kaiser Permanente 'Absolutely' Committed To Obamacare Marketplaces 
Aetna said this week it is drastically curtailing its participation on the Affordable Care Act's insurance exchanges. But one of the largest not-for-profit health insurers does not plan on abandoning them anytime soon. Kaiser Permanente, the $61 billion system that includes health plans, hospitals and medical groups, is “absolutely” sticking with the exchanges over the long term, Kaiser CEO Bernard Tyson told Modern Healthcare on Wednesday. (Herman, 8/17)

Kaiser Health News: Obamacare Marketplace Shakeout Rocks Arizona, Southeast 
Some of the Affordable Care Act’s insurance marketplaces are in turmoil as the fourth open enrollment season approaches this fall, but what’s ahead for consumers very much depends on where they live. Competition on these exchanges will be diminished next year when three of the nation’s largest health insurers — Aetna, UnitedHealthcare and Humana — will sell individual plans in many fewer markets. So too will several Blue Cross and Blue Shield plans in various states. That’s on top of the 16 nonprofit co-ops that have closed since January 2015. (Galewitz, 8/17)