Valentine’s Day insurance breakups could mean massacre for ACA exchanges

It was a rough day for the already-roiled U.S. health insurance market: One giant merger was abandoned, another is threatened by infighting, and a one of the players announced it would stop selling coverage on public exchanges in 11 states.

Both merger deals had already been rejected by federal regulators and judges, but appeals were still possibilities. Now, the deals both appear to be all but over.

Aetna Inc. said it was abandoning its planned $34 billion purchase of Medicare Advantage provider Humana Inc. early Tuesday. Then, later in the day, Cigna Corp. said it is suing Indianapolis-based Anthem Inc. to kill a $48 billion acquisition bid.

The deals were conceived as a way to help the insurers increase their enrollment and cut down on expenses in part so they could improve their performances on the Affordable Care Act's public insurance exchanges. Big insurers have been hit with substantial losses from the exchanges, even though they represent a relatively small part of their overall business. Many have already cut back their offerings, and that has slashed customer choices in markets around the country.

The collapse of one deal and the uncertain future of the other could hurt shoppers on the exchanges next year by leaving them with even fewer options and potentially higher prices. Humana told investors late Tuesday that it was abandoning it exchanges in all 11 of its states as of the beginning of next year.

Humana, based in Louisville, was the only insurer on exchanges in 16 Tennessee counties, according to data compiled at the start of the 2017 open enrollment period by the Associated Press and health care consulting firm Avalere. That means customers in those counties may have no way to buy coverage with help from government tax credits next year unless another insurer decides to enter those markets.

Every exchange in the U.S. had at least one insurer selling coverage on it for 2017, according to Larry Levitt of the not-for-profit Kaiser Family Foundation, which studies health care issues.

Morningstar insurance analyst Vishnu Lekraj said it's possible all the four insurers involved in the deals could leave the exchanges.

Aetna Chairman and CEO Mark Bertolini raised that possibility months ago. He said that if his company's planned merger was blocked, "we believe it is very likely that we would need to leave the public exchange business entirely," according to court documents filed in that case.

Aetna, based in Hartford, Connecticut, says it lost $450 million last year on ACA-compliant coverage, while the company booked an overall profit of $2.27 billion. Its loss on ACA-compliant business was $100 million more than it expected.

Bertolini said recently that his company would announce by April 1 whether it will remain in any of its exchanges. "We're looking at everything," he said.

Government and industry officials have said President Donald Trump's administration and congressional Republicans are weighing measures to stabilize the wobbly exchanges. Insurers have been pushing them to act soon.

"The clock is definitely ticking for the Trump administration to provide some clarity around what the rules will be," Levitt said.

In suing to end its tie-up, Cigna, based in Bloomfield, Connecticut, said it wants more than $13 billion in damages from its onetime-companion Anthem, the Blue Cross-Blue Shield insurer.

Cigna says it is seeking a $1.85 billion termination fee from Anthem and billions more in damages for what it says were Anthem's breaches of the merger agreement.

The insurer says the damages include the amount Cigna shareholders would have received if the merger had not failed. It noted that Anthem assumed full responsibility for litigation strategy and getting the necessary regulatory approvals, suggesting that it was Anthem's responsibility to push the deal through.

"Cigna fulfilled all of its contractual obligations and fully cooperated with Anthem throughout the approval process," the insurer said in a written statement.

An Anthem spokeswoman said Cigna has no right to end the deal, and it remains committed to closing the transaction. The insurer had just filed on Monday paperwork to appeal the federal court ruling.

Anthem and Aetna put their acquisition bids together in 2015 and touted them as a way to grow enrollment and reap savings that they would then pass on to consumers.

The deal would have given Aetna the opportunity to significantly expand its presence in Medicare Advantage coverage, which involves privately run versions of the federal Medicare program for people who are over 65 or disabled.

But the Department of Justice had sued last summer to stop the deals, due to concerns about how they may affect prices and consumer choices. Federal judges then rejected the acquisitions in separate rulings filed earlier this year.

The deals would have combined four of the nations' five largest insurers. UnitedHealth Group is the largest.