Aetna Inc. (NYSE:AET) has become the second big health insurer to drop out of America’s Health Insurance Plans (AHIP) in the last six months.
Aetna, which is in the process of acquiring Humana Inc. (NYSE:HUM), said it was leaving the health insurer trade group in a statement released Tuesday.
“Aetna has decided not to renew our AHIP membership for 2016,” the company said in the statement. “We will continue to partner with groups that are working, as we are, toward expanding access to high-quality, affordable health care.”
Marilyn Tavenner, president of AHIP, said in a statement of her own that AHIP’s successful advocacy speaks for itself.
“Our members depend on AHIP to advance their key priorities, to strengthen the public-private programs that provide coverage for millions of Americans, and to deliver solutions that improve access to high quality, affordable care for consumers,” Tavenner said.
UnitedHealth Group Inc. (NYSE:UNH) left AHIP in June.
See also: UnitedHealth leaves AHIP
Tavenner, a former Centers for Medicare & Medicaid Services (CMS) administration who helped oversee the implementation of the Patient Protection and Affordable Care Act (PPACA) provisions that affect Medicare, Medicaid and the commercial health insurance board, took over as the head of AHIP in July.
See also: Former CMS head to lead AHIP and
In the past two years, AHIP has succeeded at putting drug makers on the defensive, and focusing more public attention on the big, for-profit hospital companies.
But AHIP has been unable to keep the Obama administration from making frequent changes in PPACA exchange rules after product benefits and rates were already set, and it has been unable to get Congress to free up funding for the PPACA risk corridors program, a program that’s supposed to use cash from PPACA public exchange plan issuers that do well in 2014, 2015 and 2016 to help issuers that do poorly in those.
The amount of cash coming in from thriving issuers was much lower than CMS had hoped in 2014, and CMS has said the program may have enough cash to pay only 13 percent of 2014 program claims.
Another PPACA program, a permanent risk adjustment program, also requires some health insurers to provide cash for others. That program is supposed to move cash from insurers with enrollees with low health risk scores to insurers with enrollees with high health risk scores.
Health insurers have not said much in public about concerns about risk corridors and risk adjustment payables, but the lack of public discussion about the programs, and AHIP’s loss of two large carrier members, could reflect tension between the insurers seeking program cash and the insurers viewed as potential providers of cash.
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