Nov. 11--The solution to Obamacare's woes is to save the most popular parts of it -- such as allowing young adults to stay on family policies, prohibiting denial of coverage due to pre-existing conditions -- Aetna CEO Mark Bertolini told a business conference in New York Thursday. He also said that the expansion of Medicaid to more adults could easily be preserved, if structured differently.
"I think things like 26-year-olds on their parents' policy, I think the expansion of Medicaid, are all very important programs that we need to continue," Bertolini said in a public Q&A on the future of health care sponsored by The New York Times. "So how do those get passed going forward?"
Bertolini predicted Obamacare would be repealed under Donald Trump, but something must be devised to replace it, particularly for those with chronic illness who are now served under the Affordable Care Act.
"I mean, 81 percent of the American public hate their health insurance," Bertolini said. "They hate the health care system. We have too many uninsured, it's not affordable, even for people making six figures, so it still has to be fixed. We still need to insure everybody."
He said the federal government could use the money it is now dedicating to expanding Medicaid eligibility for block grants to states, as House Speaker Paul Ryan prefers.
"And then we have this population that really currently uses the [Obamacare] exchange, which are people between 45 and 65, who have chronic illness and can't afford their own insurance outside the exchange and need to be subsidized," Bertolini said. "They really are people that are too young for Medicare, but need the support of a Medicare-like program."
He said Hillary Clinton's proposal to open Medicare for people 50 and up who have low to moderate income "is a reasonably good solution."
Like much of America, Bertolini said Trump's election victory took his company by surprise.
"If you were to look at our game board of all the possible outcomes that could have happened in the election, this one wasn't even on the sheet," Bertolini said. "We started with a fresh piece of paper yesterday. We had no idea how to approach it."
Bertolini said Aetna's stock price went up $14 in the days after the election, because traders believe the Department of Justice under President Trump will be less likely to prevent his company's proposed merger with Humana. He said he doesn't know whether the election has any impact on the merger, which the Department of Justice has filed suit to block.
Bertolini was highly critical of the Obama administration's decision to release a letter his company wrote to the Department of Justice, which said the company would scale back its participation in Obamacare exchanges if the Aetna-Humana deal were rejected.
"There was an attempt to discredit our organization, which had been very complimentary and supportive of the [Obamacare] program, but all along very concerned about very specific parts of the deal," he said.
"We were the largest provider of exchange population the very first year, 17 markets. We were the largest carrier. The deal wasn't even a glimmer in anybody's eye back then."
Bertolini was asked how individual insurance that is not allowed to turn away people who are sick, and yet doesn't require healthy people to buy insurance could be economically feasible -- especially since Obamacare is already unprofitable.
Bertolini said Obamacare exchanges were built on the old health insurance model -- that you try to get a big pool of customers, with average risk, and then you can charge the right amount that you use to cover the costs, and don't take on too much risk.
"A flawed model," he said simply. He said what Aetna has learned through treating 75-year-old people with three chronic illnesses is that the amount of risk isn't critical, with the right approach.
"If you embrace them and you bolt a nurse to them every day, just to make sure they're taking their medications, they're getting to the doctor, they're socialized, they're active, you can actually reduce those costs," he said. "The reason the industry started taking on 75-year-olds with three co-morbidities [illnesses] is the government said: We'll pay you for taking that risk.
"So if we have an underwriting model, that says if the person's sick we'll pay you more to cover that, therefore everyone in the system, including the providers we partner with, has an incentive to drive those costs down."
Courant staff writer Stephen Singer contributed to this report.
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