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Aetna CEO commits to PPACA marketplace

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Major health insurers have said recently that they may eventually have to ditch the Patient Protection and Affordable Care Act (PPACA) individual insurance marketplace, saying that the pool of consumers they’re covering simply isn’t profitable.

UnitedHealthGroup, the largest private insurer in the country, has hinted that 2016 is the marketplace’s last chance to prove itself worthy of the company’s participation.

Even if they’re not making big bucks on Obamacare, it’s not as if health insurers are hurting. Despite its $245 million of losses on its PPACA business, UnitedHealth, for instance, reported a profit of $1.22 billion last year.

In this context, the CEO of the second largest insurer, Aetna (currently in the midst of a bid to buy Humana), is signaling that his company plans to stick with the marketplace, despite the lackluster beginning.

The pledge from Mark Bertolini likely reflects the belief that as the business matures, insurers will be able to make it profitable. However, his stated commitment to the marketplace is also political; it sends the message that the insurer is willing to do something for the good of the country, even if it may conflict with its business interests.

Acting publicly as a cooperative partner in expanding health coverage is important as the Obama administration does its part to try to reduce losses that insurers have been experiencing through the marketplace.

Just last week the administration announced that those who seek to enroll in marketplace plans outside of the open enrollment period will have to show proof that they qualify for one of the “special enrollment” periods. The administration took that action in response to complaints from insurers that people were abusing the special enrollment periods to enroll in plans only when they needed medical services.

Bertolini emphasized that he believes the marketplace needs to be improved. He suggested plans designed more specifically to appeal to younger enrollees.

“Young people pay some amount of premium, pick a number, and have a $5,000 deductible and go to the doctor once a year and pay all in cash,” Bertolini told Kaiser Health News. “For people under 35, their definition of health is looking good in their underwear. How does that program support their view of what’s good health?”