New Medica chief charts course in rough waters

March 11--In the Trump era, communication via Twitter is king -- even for a regional health insurer like Medica.

Last month, the chief executive of health insurance giant Aetna Inc. told a conference in New York that new government-run exchanges created under the federal Affordable Care Act are in a "death spiral."

Mark Bertolini, the Aetna CEO, gave the example of Nebraska, telling the crowd that Aetna was the only carrier left on the insurance exchange there.

"There isn't any risk sharing going on in Nebraska. It will cost us a lot of money," Bertolini was quoted as saying in the Washington Post.

It turns out that Aetna is not the only insurer on the exchange.

Minnetonka-based Medica also sells coverage through the Nebraska exchange. Once the newspaper's story was posted online, Medica tweeted its correction at the newspaper, reporting that the business actually is "doing well."

Telling Medica's story in the individual market is just one of the challenges facing John Naylor, the new chief executive at Medica who in January replaced longtime CEO David Tilford.

The transition came just after Medica closed the books on its worst year ever financially, due in large part to losses in the market where it serves as a managed care organization in the state's Medicaid program.

When financial results for all three key Medica insurance divisions are released next month, the insurer say the filings will show an operating loss of $270 million on $4.5 billion in revenue.

"Medica did have its worst financial year in history last year," Naylor said in an interview.

To turn the ship, Medica has made changes including a decision to drop on May 1 the state Medicaid contract that drove most of the loss. The 2016 results, in fact, include an estimated $55 million in losses on the contract during the first four months of 2017, Naylor said.

Medica lost money in 2016 on the individual market in its home state of Minnesota, where regulators say the market nearly collapsed for 2017. The individual market serves the self-employed or those not covered through an employer or government program.

Many carriers have posted significant losses in the individual market since major health law changes kicked in during 2014, and Naylor said one of the pressing issues going forward for Medica is encouraging lawmakers to fix Minnesota's market. A proposal at the Legislature to create a "reinsurance" program that would provide a financial safety net for insurers in the market "is a must," Naylor said.

But the problems with the Minnesota individual market mask the fact that markets in other states, including Nebraska, are more stable, Naylor said. Medica sells individual coverage in Iowa, Kansas, North Dakota and Wisconsin, as well.

Minnesota's individual market shrank by about 80,000 people this year, or 30 percent. Other states aren't seeing that kind of instability, Naylor said.

Cynthia Cox, a researcher with the Kaiser Family Foundation, offered a similar assessment. Minnesota and a few states have seen premium spikes and enrollment problems pointing to a worsening risk pool, Cox said, but she doesn't think the exchanges overall are in a death spiral.

"Enrollment has held more or less steady nationally and among young adults," she said via e-mail. "I think it's unlikely for the marketplaces to enter a true death spiral, given that premium tax credits keep most enrollees from feeling the effect of rising premiums."

While Medica had troubles in 2016, the health plan's business selling to employer groups grew and was profitable during 2016, Naylor said. The insurer hopes to build on that for 2017.

Selling coverage to employer groups has been a big part of Medica over the years, Naylor said, adding that it's the side of Medica he joined upon arrival in 2010. Previously, he worked at Willis Towers Watson (formerly Towers Perrin) for 21 years.

Naylor grew up in St. Louis, where he told a high school counselor about his goal of a career that combined mathematics and business. The counselor handed him a brochure about becoming an actuary.

"Despite the 2016 losses, Medica is still financially strong," Naylor said. "We are positioned to continue to be a leader in this space."

Twitter: @chrissnowbeck

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