Aetna CEO: Obamacare in 'Death Spiral'

Aetna Inc. Chief Executive Officer Mark Bertolini escalated his criticism of the Affordable Care Act, saying Obamacare’s markets are nearing failure as premiums climb and healthier individuals drop out.

“It is in a death spiral,” Bertolini said in a video interview with the Wall Street Journal that aired Wednesday on the newspaper’s website. He predicted that more insurers will drop out of the market for 2018, following Humana Inc.’s decision to quit Obamacare entirely for next year.

Aetna, too, is mulling whether to further reduce its presence in the markets set up by the ACA. The company cut its footprint to four states for this year, from 15, after losing about $450 million on sales of ACA plans last year.

Bertolini has been saying for months that the ACA’s markets are deteriorating. In October, he said that rising rates would push healthy people away from Obamacare, leaving insurers with sicker customers, and forcing premiums even higher. The increasing burden of medical costs as fewer and fewer healthy customers enroll are among the conditions that create an insurance death spiral.

Some health-care experts have disputed the idea that Obamacare is experiencing a death spiral. Matthew Fiedler, a fellow with the Center for Health Policy at the Brookings Institution, says the small decline in Obamacare enrollment in 2017 compared to 2016 was probably not driven by climbing premiums. Most individuals get subsidies, helping cushion the effect of rising costs.

“Marketplace premium increases had little if any impact on marketplace sign-ups, providing strong evidence against claims that these increases would send the individual market into a death spiral,” he wrote in an analysis published Feb. 8 on the Brookings website.