Editorial: Aetna’s withdrawal from Obamacare exchanges isn’t the start of a death spiral

Aetna, Inc. headquarters
Aetna Inc. headquarters in Hartford, Conn., in 2014.
(Jessica Hill / Associated Press)

Giant insurer Aetna announced this week that it was withdrawing from the Obamacare exchanges in 11 of the 15 states it had been doing business, becoming the third major insurance company to scale back its offerings dramatically in the face of heavy losses. The news led to a chorus of “I told you so’s” from critics of the 2010 healthcare law, who have long predicted that it would collapse under its own weight. But they are confusing the growing pains of a new market with the death rattle of a failing one.

[Obamacare has] barred insurers from denying coverage or charging higher rates to those with preexisting conditions.

It’s important to bear in mind what Obamacare, formally known as the Patient Protection and Affordable Care Act, set out to do. Over the long term, it sought to improve the quality of healthcare and rein in costs — an ambitious effort that may not yield significant results for years, if ever. In the short term, its goal was to extend insurance coverage to millions of uninsured Americans. To do so, it barred insurers from denying coverage or charging higher rates to those with preexisting conditions, required all adults to obtain coverage and offered subsidies to help poorer households pay their insurance premiums.

These changes reinvented the market for individual policies, which serves those not covered by large employer plans or government-run health programs. No longer could insurers minimize their risk by denying coverage to or gouging those with preexisting conditions. The new subsidies also attracted many previously uninsured people who had no track record to guide insurers on their needs and costs. 


The result was a hotly competitive market with winners and, yes, losers. The insurance companies that have done well include those with experience serving low-income communities, as well as those in states such as California that have worked hard to bring young and healthy customers into the market. But Aetna and UnitedHealth, which announced in April that it would withdraw from almost all the Obamacare exchanges it had entered, had previously focused on serving large employers, a much less risky and volatile market.

Policymakers haven’t provided much help, as the partisan split over Obamacare has prevented almost every effort to improve the law or fix the problems that have emerged. But the biggest factors in the current shakeout appear to have been insurers’ setting premiums too low to pay for the care demanded by the newly insured, and many states’ inability to bring enough of the younger, healthier uninsured into the individual market.

Those problems should fade over time as this market matures. Lawmakers could help matters with more aggressive efforts to improve efficiency in the healthcare industry, while also providing better safeguards for insurers stuck with unusually expensive customers. In the meantime, it’s unfortunate that the number of insurance choices are shrinking in many states’ Obamacare exchanges. But that’s a predictable result of the major and overdue changes the law brought about, not a sign of its failure.

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