Aetna opts out of Ohio insurance exchange

Firm owns company that will participate

Aetna headquarters in Hartford, Conn.

COLUMBUS — The nation’s third-largest health insurer has opted not to participate in Ohio’s online, federally run insurance market designed to help individuals facing a Jan. 1 deadline to find coverage.

Aetna had submitted multiple policies with differing levels of coverage and pricing for the approval of the Ohio Department of Insurance. But the Connecticut-based company notified the state shortly before a July 31 deadline that it was pulling out.

The insurer recently bought Coventry Health Care, which also had submitted proposals in Ohio.

“The decision in Ohio was made after we took a long view at both Aetna state-by-state and Coventry state-by-state,” Aetna spokesman Susan Millerick said. “Ohio is one of the markets where we chose to pull Aetna and leave Coventry. There was no need to have two separate plans in the exchange. We found the Coventry plan to be the most competitive, so we withdrew the Aetna offering.”

In addition to Coventry, 12 other insurers submitted some 200 differing plans to Ohio. Six of those — Coventry not among them — have also submitted 184 differing small-group plans.

“The feds are going through their process in terms of contracts and working with companies to get them on the exchange,” insurance department spokesman Chris Brock said. “We don’t expect any other changes at this point.”

Ohio opted not to run its own exchange, leaving that task to the federal government. The exchange is designed to be a marketplace where private insurance companies would compete for the business of Ohio individuals and small employers under the Patient Protection and Affordable Care Act, sometimes called Obamacare.

The state has retained its authority to regulate the companies that participate in the exchange. Aetna was the sole company out of 14 that submitted a menu of policies that decided not to follow through.

Ms. Millerick said the company is being cautious not to overexpose itself in the first year of the untested exchanges. In some cases, decisions to withdraw from Ohio’s exchange were because of state restrictions on the premiums the companies could charge.

Both Aetna and Coventry pulled out of exchanges in Georgia and Maryland. Coventry pulled out of Texas, leaving Aetna behind. Aetna pulled out of the exchange in its home state of Connecticut. Neither company sought to be involved in Michigan’s exchange.

Consumers may begin shopping for policies on the exchanges on Oct. 1.

Lt. Gov. Mary Taylor, who doubles as director of the insurance department, last week reported that, based on the policies submitted to the exchange, individuals would pay an average of 41 percent more than they did this year.

Small businesses or groups would pay 18 percent more, she said. The Republican lieutenant governor, an Obamacare opponent, cited the additional coverage mandated by the federal law as a factor.

“Ohioans were promised that under Obamacare, health insurance would become more affordable and more accessible,” said Eli Miller, state director of Americans for Prosperity-Ohio, a conservative group that has aired ads critical of the federal health-care law.

Critics, however, contend that the lieutenant governor’s numbers misrepresent what would happen in the real world where consumers in exchanges would have a choice between competing policies and where many would have their decisions federally subsidized.

Kathleen Gmeiner, project director of Ohio Consumers for Health Coverage, said the fact 13 other players are involved in the exchange “suggests a lot of confidence that insurance companies will be able to survive and thrive in this market,” she said.

While open enrollment begins Oct. 1, she does not expect a lot of people who are uninsured to act until they go to their tax preparers and learn they will have to provide proof of insurance on their returns.

Another option designed to help lower-income Ohioans to find coverage is the proposed expansion of Medicaid, the federal-state health insurance of last resort.

Gov. John Kasich bucked his own party in advocating expansion to those earning 38 percent above the federal poverty level, about $32,000 a year for a family of four. The state has estimated this would add some 275,000 mostly childless adults to the rolls with the federal government picking up all the costs for the first three years and no less than 90 percent thereafter.

Rep. Barbara Sears (R., Monclova Township) has become a target by conservative groups for a possible GOP primary election challenge next year because, despite her opposition to the Affordable Health Care Act, she has argued that the numbers make sense for Ohio.

She plans to soon introduce a series of Medicaid reform bills, including one authorizing expansion, on top of measures she has introduced.

Contact Jim Provance at:jprovance@theblade.com or 614-221-0496.