Tit for tat: How the DOJ's lawsuits may have a ripple effect disrupting the ACA exchanges

Leading national payers have suffered big losses on the Affordable Care Act exchanges, and many payers seek consolidation as a means to thrive in the competitive insurer marketplace. However, antitrust regulators are concerned the pending payer deals will cut competition, leading to the Department of Justice to file suits against the pending Anthem/Cigna and Aetna/Humana mergers.

Following the suit, Humana pulled out of many ACA exchanges, saying it will participate in "no more" than 11 state marketplaces after suffering $1 billion losses in 2015. The payer is also reducing the number of counties where it will offer individual plans. The payer is reducing this figure from 1,351 counties this year to only 156 counties in 2017, according to Motley Fool. Humana's exit may impact consumers as hundreds of enrollees would be forced to find new plans.

Anthem has employed an entirely different approach, claiming it will add nine more ACA state exchanges if its deal with Cigna comes to fruition. The company claims its Cigna deal will help control pricing in the payer marketplace and will help strengthen Anthem's commitment to the public exchanges.

Motley Fool reported it is unclear at this time whether the DOJ suits will impact Anthem and Aetna's ACA offerings, but the marketplace may struggle if the large payers do withdraw as smaller insurers may not have sufficient resources to pick up the slack.

More articles on coding & billing:
5 things to know about high-risk pools for insurance
Anthem seeks quick, separate trial to keep $45B Cigna deal on the table: 5 key notes
43 states fell short in price-transparency law report card: 6 things to know

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Whitepapers

Featured Podcast