In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

2. Licensing Logjam For California Nurses

A big backlog of applications at the state’s licensing board is holding up hiring by hospitals and making it difficult for recent nurse graduates — and experienced nurses from out of state — to work. (Eryn Brown, 8/17)

3. Political Cartoon: 'Going The Extra Mile'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Going The Extra Mile'" by Rick McKee, The Augusta Chronicle.

Here's today's health policy haiku:


Doctor’s appointment …
But no way to get to it?
Why not use Uber?

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

4. Long-Term Stability Of ACA In Doubt As Insurers Continue To Jump Ship

“The exchanges are a mess as they exist today,” says Aetna's CEO Mark Bertolini. The company is the latest insurer to announce it is pulling out of most markets.

Bloomberg: Obamacare’s In Trouble As Insurers Tire Of Losing Money 
Last November, when UnitedHealth Group said it expected to post big losses on its Obamacare policies in 2016, rivals such as Anthem and Aetna signaled their Affordable Care Act businesses were doing fine. The Obama administration used that as evidence to refute claims that systemic problems were brewing in its landmark insurance program. Now, there’s no denying it. The four biggest U.S. health insurers admit they’re each losing hundreds of millions of dollars on their Obamacare plans. Rather than expand coverage, many are pulling out of the exchanges that were set up by the ACA so people can shop for insurance plans, often with the help of government subsidies. (Tracer, 8/17)

The Hill: Insurer Exit Darkens ObamaCare Picture 
Aetna’s decision to pull back from ObamaCare is fueling new questions about the long-term viability of the Affordable Care Act (ACA). When United Healthcare announced in April that it was leaving most ObamaCare marketplaces in 2017, supporters of the law argued against drawing broad conclusions, calling it one company’s decision. (Sullivan, 8/16)

USA Today: Aetna's Exit Deals Blow To Obamacare, Patients
Health insurer Aetna announced late Monday that it is dropping Obamacare insurance in 69% of the counties and 11 of 15 states where it currently offers plans. ... Here's what that means for patients, insurers, the ACA and the company's fight with the government over its effort to acquire Humana. (Bomey, 8/16)

The Fiscal Times: With Aetna Pulling Out, Can Anything Save Obamacare?
The disclosure Monday that insurance giant Aetna will pull out of the Obamacare market next year in 11 of the 15 states it now serves poses a serious threat to the future of the program and raises anew the need for major reforms. ... Larry Levitt, a senior vice president of the Kaiser Family Foundation and a strong champion of the Affordable Care Act, said in a tweet today that the next Obamacare open enrollment period for 2017 will be key in determining the importance of Aetna’s stunning withdrawal from the program’s exchanges. (Pianin, 8/17)

Modern Healthcare: Aetna Pullout Heightens Pressure For ACA Exchange Fixes As Elections Near 
The startling withdrawal of Aetna from many Affordable Care Act exchanges has accelerated the search for ways to preserve competition in those markets. Options being considered include establishing government-run plans and requiring insurers to offer exchange products as a condition for participating in Medicare Advantage or Medicaid managed care—or as a concession for proceeding with proposed mergers. (Meyer, 8/16)

Morning Consult: Report Suggests Medicare Advantage, Part D Policy Fixes Could Be Applied To ACA Exchanges
The insurance marketplaces created under the Affordable Care Act face some similar challenges that public insurance programs have faced as they’ve gotten off the ground. Steps that were taken to stabilize Medicare Advantage and Medicare Part D could be a starting point to stabilize the ACA insurance exchanges, a policy brief released Tuesday by the Robert Wood Johnson Foundation suggests. (McIntire, 8/16)

Politico Pro: Obama Allies Cry Foul Over Aetna Snub
Obamacare backers are suspicious of the timing of Aetna’s decision to back out of most of the law’s insurance markets, suggesting the nation’s third largest carrier is trying to strong-arm the Obama administration into approving its controversial merger with another insurer. Aetna CEO Mark Bertolini dealt a big blow to Obamacare on Monday night, announcing the company will pull out next year from all but four of the 15 state online markets where it sells health plans. He cited unsustainable losses of $430 million since 2014. (Demko and Pradhan, 8/16)

5. Some States To Be Left With Few Or No ACA Options After Aetna's Pullback

Media outlets report from Arizona, Iowa, Georgia, Florida, Pennsylvania and Texas on what Aetna's exit from most health law marketplaces means for the states.

The Associated Press: Insurers Continue To Abandon ACA Exchanges, Limiting Choice
Aetna will abandon Affordable Care Act insurance exchanges next year in more than two-thirds of the counties where it now sells the coverage, the latest in a string of defections by big insurers that will limit customer choice in many markets. Dwindling insurer participation is becoming a concern, especially for rural markets, in part because competition is supposed to help control insurance price hikes, and many carriers have already announced plans to seek increases of around 10 percent or more for 2017. (Murphy, 8/16)

Bloomberg: Insurer Exits From Obamacare Turn Few Choices Into None 
The 400,000-population county southeast of Phoenix currently doesn’t have a single health insurer offering coverage next year on the Affordable Care Act’s exchanges, where Americans can shop for the insurance they’re required to have under the law. With the impending pullout of major health insurers -- including Aetna Inc., UnitedHealth Group Inc., and Humana Inc. -- Pinal County is just one place around the country where Americans will be left with few, if any, choices for coverage. (Tracer and Darie, 8/16)

Arizona Republic: Aetna Plans To Drop Affordable Care Act Health-Insurance Coverage In Arizona
With health-insurance giant Aetna dropping Affordable Care Act coverage in Arizona and 10 other states next year, Pinal County residents could be left without a health-insurance marketplace option unless another insurer adds coverage to the fast-growing county. Aetna planned to expand in Pinal, and was poised to be the county's only marketplace option when coverage for the new year begins Jan. 1. But the insurer announced this week that it would drop ACA plans in Pinal and Maricopa counties as part of a nationwide pullback. (Alltucker, 8/16)

The Hill: Arizona County At Risk Of Having No ObamaCare Option 
Aetna’s retreat from most ObamaCare marketplaces this week is rippling across rural America, starting with Pinal County in Arizona. The county, which has a population of about 400,000, no longer has any insurers planning to sell coverage through ObamaCare next year. (Ferris, 8/16)

The Star Tribune: Aetna Exiting Exchanges ... But Stays In Iowa, Nebraska
Connecticut-based health insurance giant Aetna added to the drumbeat of woes for the nation's health insurance exchanges on Monday evening by announcing exits from most of the 778 counties where it currently competes. Aetna will continue to sell exchange policies in 242 counties across four states -- Delaware, Iowa, Nebraska and Virginia. (Snowbeck, 8/16)

Georgia Health News: Another Big Defection From Georgia Insurance Exchange
Aetna says it will pull out of the insurance exchange in Georgia and 10 other states in 2017, further limiting consumers’ choice of health plans here under the Affordable Care Act. The insurance giant is following on the heels of another major insurer, UnitedHealthcare, in dropping exchange coverage for individuals in Georgia and several states. Separately, state insurance officials told GHN on Tuesday that Cigna also won’t offer exchange plans in Georgia next year. Cigna officials could not be reached for comment by late afternoon. An exit by Cigna, which currently has about 1,500 members in the exchange, would leave just six health insurers in the ACA marketplace in the state, down from nine this year. (Miller, 8/16)

Health News Florida: Aetna’s Exit Leaves Floridians With Fewer Obamacare Options
Next year Aetna will stop offering health insurance on the Affordable Care Act's public exchanges in Florida and 10 other states. The move leaves Floridians with fewer choices and ever increasing rates. So far, 11 companies have requested to sell insurance in Florida on the federal exchanges in 2017. That's down from 19 insurers in 2016. (Ochoa, 8/16)

The Philadelphia Inquirer: Aetna Pulls Out Of ACA Exchange In Pa.
Aetna Inc.'s decision to withdraw from Affordable Care Act exchanges in Pennsylvania and 10 other states means that Independence Blue Cross will be the only major firm offering individual plans for 2017 to Southeastern Pennsylvania residents. Aetna serves about 31,000 Pennsylvanians through the marketplace, about 6 percent of the state's individual health insurance market, according to the Pennsylvania Insurance Department. Coverage for those people will not change this year. (Brubaker, 8/17)

Dallas Morning News: Seven More Texas Counties Could See Just One Obamacare Option In 2017
Last year, at least 50 of the state’s counties had only one insurer to offer an individual market plan, according to data from the Texas Department of Insurance. With Aetna’s pull-out, another seven could find themselves in that situation in 2017, unless other plans are introduced to those areas. With a population of just over 116,000, Parker County just west of Fort Worth is the largest. The others counties include: Colorado, Matagorda, Palo Pinto, San Jacinto, Wharton and Wilson.  (Rice, 8/16)