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PPACA’s future may rest on patience of Aetna, Anthem

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(Bloomberg) — The fate of the Patient Protection and Affordable Care Act (PPACA) – Obamacare – may depend on how long Anthem Inc. (NYSE:ANTM) and Aetna Inc. (NYSE:AET) are willing to wait before starting to make money off it.

See also: PPACA earnings messages: Anthem, Assurant and moreModa shrinks, Aetna rises, analysts watch and Humana may slash individual health operations

The two insurers are on the hot seat now that UnitedHealth Group Inc. (NYSE:UNH) appears unlikely to linger as a seller on the PPACA public exchange system. UnitedHealth, the largest U.S. health insurer, said Thursday that if it can’t turn a profit, in 2017 it may quit the health plan marketplaces where millions of Americans buy coverage.

While UnitedHealth has a small share of that market, Anthem and Aetna are two of the biggest players. Like UnitedHealth, neither has had financial success there — Aetna has said it’s losing money, while Anthem is making less than it would like. They’re both working to widen profit margins and have said their strategy is based on the expectation that covering people under the law will become more profitable.

“It looks like it’s more of a United issue, with some flavoring of national issues,” Bill Melville, an analyst who focuses on health insurance exchanges at Decision Resources Group, said by phone. “It’s a wake-up call that there’s been some pretty rough headwinds.”

Worrying signs

There have been other worrying signs. Already 12 of the 23 nonprofit, member-owned Consumer Oriented and Operated Plan (CO-OP) carriers created to sell insurance under PPACA have said they’re closing down, overwhelmed by financial losses.

UnitedHealth’s shares slumped 5.7 percent to $110.63 on Thursday. Aetna and Anthem fell more, signaling investors are worried their businesses may be deteriorating as well. Aetna recovered some ground in early trading on Friday after the insurer said it hasn’t seen any deterioration in its individual business through the end of October.

Peter Costa, an analyst at Wells Fargo & Co, said Thursday that he expects Anthem and Aetna to lose money on the exchanges next year, potentially leading them to reconsider their postures.

“We believe UnitedHealth’s commentary that it would only participate in this market in 2017 if it expected to at least break even for the year is indicative of the mindset of many insurers,” Costa said. “We expect that the experience of insurers will either improve in 2017 and beyond, or they will choose to no longer participate in the market.”

David Windley, an analyst at Jefferies, said some insurers could improve their financial results by leaving the PPACA exchange system.

“Exiting the exchange market would likely indicate that the entire marketplace experiment has failed, thus no longer a threat to cannibalize commercial group business, and yield higher” earnings per share, he said in a note late Thursday.

Representatives for Aetna and Anthem declined to comment, referring to comments made as recently as last week that they were willing to be patient. Aetna had said on Nov. 10 that it was working to break even in the exchanges next year, and on Friday said its individual business is performing “in line with its projections” through the end of October.

‘Too early’

“It’s way too early to call it quits on the and on the exchanges,” Aetna CEO Mark Bertolini said on an Oct. 29 conference call held to discuss third-quarter financial results. “We view it still as a big opportunity.”

Anthem echoed those remarks. In late October, Chief Financial Officer Wayne DeVeydt said the company is willing to wait a few years for the Obamacare exchange business to improve.

“We are going to need to be patient until this works itself out, which we hope will be by 2017 and 2018,” DeVeydt said. “What we thought would be a tailwind going into 2016 is probably going to be a headwind.”

The Obama administration said UnitedHealth’s announcement isn’t a sign of larger problems.


“The reality is we continue to see more people signing up for health insurance and more issuers entering the marketplaces,” Ben Wakana, a spokesman for the Department of Health and Human Services (HHS), said in an e-mail. “Today’s statement by one issuer is not indicative of the marketplace’s strength and viability.”

America’s Health Insurance Plans (AHIP), which lobbies on behalf of the industry, said Thursday that the U.S. needs to do more to improve the marketplaces. UnitedHealth isn’t an AHIP member.

Health plans are particularly upset that the administration paid out claims in a program designed to stabilize the marketplace at less than 13 percent of what insurers requested. The payouts were low because more insurers lost money than made money, though the U.S. has promised to make up the payments in future years. UnitedHealth, which today cut its 2015 profit forecast, didn’t incorporate payments from the program into its 2015 and 2016 forecast.

‘Serious challenges’

“We’ve been very clear with the administration about the serious challenges facing consumers and health plans in this exchange market,” AHIP CEO Marilyn Tavenner said in an e-mailed statement. “When health plans cannot rely on the government to meet its obligations, individuals and families are harmed as a result. The Administration must act to ensure this program works as intended and consumers are protected.”

Another challenge for insurers has been slowing enrollment growth. HHS has said it expects about 10 million people will be enrolled at the end of 2016, compared with 9.1 million at the end of this year.

Other insurers have said they’re doing fine.

Centene Corp. (NYSE:CNC) on Thursday reiterated its 2015 profit forecast and sad its health insurance marketplace business “continues to perform in line with expectations.” And Kaiser Permanente, which has about 450,000 individual exchange customers across eight states and Washington, D.C., said it’s “strongly committed” to the marketplaces.

—With assistance from John Tozzi.


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