Aetna executives testify in court, defend ACA withdrawal: 5 things to know

U.S. Department of Justice lawyers questioned Aetna executives Monday about the payer's decision to exit the majority of ACA exchanges it operated in during an antitrust trial challenging Aetna's proposed $37 billion takeover of Humana, according to The Wall Street Journal.

In a July 5 letter, Hartford, Conn.-based Aetna warned the DOJ it would reduce its 2017 ACA exchange footprint if the DOJ sued to enjoin its acquisition of Louisville, Ky.-based Humana. On July 21, the DOJ sued the payers over concerns their deal would hamper competition in Medicare Advantage and ACA exchange markets. Then on Aug. 15, the insurer said next year it would exit 11 of the 15 state ACA exchanges it operated in.

Here are five things to know about the executives' testimonies.

1. The DOJ argued Aetna exited the exchanges to avoid antitrust claims that the Aetna-Humana deal would impede ACA exchange competition in 17 counties spanning Florida, Georgia and Missouri. However, Aetna CEO Mark Bertolini said Aetna's decision was based on business, citing financial losses on the exchange that could amount to $350 million for 2016.

2. Aetna's head of exchange business Jonathan Mayhew testified if the decision had been up to him, Aetna would no longer participate in any exchanges. He said the business "has continued to deteriorate as the year has progressed," reports The Wall Street Journal.

3. The DOJ presented internal Aetna emails discussing the insurer's actions in the 17 counties identified by the department. At least one email discussion involved questions about whether leaving the Florida market was a good business move. On the witness stand, Mr. Mayhew also said he had been told to keep decisions about Aetna's operations in the 17 counties verbal so written documentation could not be shared with the DOJ, according to the report.

4. The DOJ also argued an Aetna-Humana deal would impede competition in the Medicare Advantage market. Mr. Bertolini testified Aetna and Humana's divesture plan — selling $117 million worth of Medicare Advantage assets to Long Beach, Calif.-based Molina Healthcare — would address the DOJ's antitrust concerns. U.S. District Judge John Bates may allow the transaction to progress if he agrees with Aetna and Humana's argument that their Medicare Advantage assets compete with traditional Medicare run by the government, Reuters reports.   

5. Mr. Bertolini also testified he had "high expectations" that an Aetna-Humana deal would save $3 billion in costs and efficiencies if approved.   

More articles on payer issues:
27% of Americans today would be uninsurable pre-ACA, Kaiser Family Foundation finds
CHIP enrollment up 11% in Pennsylvania
Humana extends coverage to colon cancer test Cologuard

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