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Change Is In The Works For Humana ACA Exchange Participation

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Humana became the latest health insurer to serve notice that it might leave some Affordable Care Act exchanges next year, creating more uncertainty for customers ahead of this fall's enrollment window and presidential campaign, during which the law is sure to remain a hot debate topic.

The insurer, which is being acquired by rival Aetna, said Wednesday that it expects to make a number of changes to its business for 2017, and that may include leaving some markets both on and off the exchanges or changing prices. Humana Inc. sold coverage in 15 states this year.

"We do not take these changes lightly," spokesman Tom Noland said in an email. "We are striving to avoid unnecessary coverage disruption wherever possible."

Several insurers say they have struggled with sicker-than-expected customers and had a hard time attracting younger, healthy people to the coverage they sell on the ACA's state-based public insurance exchanges, which opened for enrollment in the fall of 2013. Some also have been hurt by temporary government support programs that haven't delivered as they were initially advertised.

UnitedHealth Group Inc., the nation's biggest insurer, said last month that it was chopping its participation in the exchanges down to only a handful of states in 2017 after expanding to 34 for this year. Aetna Inc. has said it lost more than $100 million last year on its exchange business, but it still sees potential in the new market.

The exchanges provide coverage to more than 12 million people, many of whom receive income-based tax credits to help pay the bill. Insurers have entered and left markets or dropped unprofitable coverage in several states during their first few years, as they searched for the right business mix.

Two companies that report exchange success so far, Molina Healthcare Inc. and Centene Corp., say they have focused on covering low-income customers in markets where they already have an established presence in Medicaid, the state-federal program that covers the poor. Molina sells coverage in nine states and is thinking about adding two for next year.

Another insurer, Cigna Corp., is considering expanding its presence beyond the seven states it currently serves.

Humana didn't detail the changes it expects to make for 2017. Noland said Wednesday that the company remains committed to offering affordable individual coverage "wherever practical" on the exchanges.

Several industry observers say they expect insurers to seek significant premium hikes in many markets. Final rates will come out later this year, and enrollment for 2017 coverage will begin Nov. 1, a week before the presidential election.

The ACA and its future have already come up on the campaign trail. Republican Donald Trump has said he wants to replace the law. Democrat Hillary Clinton wants to expand it, and Vermont Sen. Bernie Sanders would weave it into a bigger, government-run system.