Judge: Aetna Misled Public On Departure

HEATHER STAUFFER

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Health insurer Aetna misled the public about why it pulled out of the health care law marketplace in 11 states including Pennsylvania, a federal judge concluded this week.

"Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ (Department of Justice) regarding the proposed merger," United States District Judge John D. Bates wrote in a ruling that blocks the insurer from buying rival Humana Inc.

Aetna and Humana are among the nation's largest health insurance companies.

Aetna said it was withdrawing because it was losing money on health plans sold through the marketplaces. However, Bates wrote that some of the marketplaces it withdrew from were profitable, and that an executive testified Aetna leaders discussed the decision via phone to avoid leaving a paper trail.

The ruling listed Florida as a state where Aetna made money in the marketplace in 2016; it did not comment specifically on Pennsylvania.

Although Aetna exited the state marketplace entirely for 2017, it elected to offer off-marketplace, unsubsidized plans in about half of Pennsylvania's counties, often significantly cheaper than its on-market competitors.

Lancaster was not among those chosen counties, but numerous others in the region were, including Dauphin, Chester and York.

Neither Aetna nor the Pennsylvania Insurance Department would comment on how the insurer decided where to offer plans.

However, department spokesman Ron Ruman said in an email that the law would allow Aetna to offer plans in any county it wanted to in 2018, on or off the marketplace.