President Obama has become the de facto chief marketing officer for a large, struggling health insurance shopping mall. (Photo:White House)

(Bloomberg) — President Barack Obama met with top executives from more than a dozen health insurers, including Humana and Cigna Corp., to re-affirm his support for the Affordable Care Act and the ACA exchange system after several companies retreated from the law’s government-run insurance markets.

Obama dropped in on a meeting on Monday in Washington between top White House health officials and the executives before the 2017 enrollment period, according to a White House official. Earlier in the day, the president sent a letter to all companies offering coverage through the ACA public exchange system.

Related: Obama holds health meeting

“We know that this progress has not been without challenges. Most new enterprises have growing pains and opportunities for improvement,” Obama wrote in the letter. “The marketplace, while strong, is no exception.”

The president is trying to bolster the core of his signature health care law at a time when it is under strain because of an exodus of major insurance companies. Aetna said last month it would reduce sales of ACA plans next year in 11 of 15 states where it had participated. UnitedHealth Group and Humana have also said they’re pulling out, citing hundreds of millions of dollars in losses.

“Today’s meeting was focused on how to build on the continued progress in reducing the uninsured rate and moving forward with policy solutions that will support a stable, affordable market for 2017 and beyond,” Clare Krusing, a spokeswoman for the Washington-based America’s Health Insurance Plans, said in an e-mail.

Younger, healthier

Republicans have pointed to large premium increases for 2017 in many states as a sign of trouble with the law, and continue to advocate for its repeal. Enrollment season begins Nov. 1, a week before the U.S. presidential election.

In his letter, Obama said his administration was working on ways to boost enrollment among younger, healthier people, who are essential to balancing the risk of covering sicker, healthier people. The White House will hold a “Millennial Outreach and Engagement Summit” this month to increase youth enrollment in the insurance marketplaces.

“Since the remaining uninsured are disproportionately younger and healthier, signing them up improves the risk pool and consequently the affordability of coverage for all enrollees,” he wrote.

Related: Obama addresses AMA

Executives from Aetna, which is based in Hartford, Connecticut, and UnitedHealth, which is based in Minnetonka, Minnesota, did not participate in the meeting. Bruce Broussard, the CEO of Louisville, Kentucky-based Humana, did attend, according to the White House. Indianapolis-based Anthem, the largest for-profit insurer broadly participating in the program, said its chief executive officer, Joseph Swedish, was invited to attend but had a scheduling conflict. The companies involved in the meeting represented a wide range of insurers, including non-profit and for-profit firms, a White House official said.

A person familiar with the conversation who asked not to be identified discussing a private meeting said that insurers told Obama and White House officials that the government should crack down on people who try to wait until they get sick to sign up for coverage, among other moves that would stabilize the program and make it easier for plans to turn a profit.

“It’s important to the people and communities we serve to have access to affordable health care options,” said Scott Serota, CEO of the Chicago-based Blue Cross Blue Shield Association and a participant at the meeting. “To achieve this, the rules must encourage people to be continuously insured so they get the ongoing care they need. We continue to work with the administration toward this critical goal.”

About 11.1 million people were signed up for ACA exchange plans at the end of March.

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