Issue link: https://beckershealthcare.uberflip.com/i/731691
74 CFO / FINANCE 7 Things to Know About Aetna's ACA Exchange Exit By Morgan Haefner H artford, Conn.-based Aetna will leave a majority of state exchanges next year, adding to a tumul- tuous year for Affordable Care Act exchanges nationwide. Here are seven things to know about Aetna's exit. 1. The insurer warned the U. S. Department of Justice in a July 5 letter it would immediately take action to re- duce its 2017 ACA exchange footprint if the DOJ sued to enjoin its acquisition of Louisville, Ky.-based Humana. 2. In the letter signed by Aetna CEO Mark Bertolini, the insurer said if its transaction with Humana is blocked, it is "very likely" the insurer would exit the public exchange entirely. However, if the deal closes, Mr. Bertolini said Aetna will explore how it can support "more public ex- change coverage over the next few years." 3. On July 21, the DOJ sued to block the $37 billion Aet- na-Humana deal over antitrust concerns. The DOJ joint- ly challenged a merger between Indianapolis-based Anthem and Bloomfield, Conn.-based Cigna. Trial pro- ceedings are set to begin Dec. 5 in the Aetna-Humana case with a planned mid-January ruling. 4. On Aug. 15, Aetna said it will pull out of 11 of its 15 state ACA exchanges next year, citing $430 million in losses on its individual plans since January 2014. 5. Kevin Counihan, director and marketplace CEO, told Politico Aetna's departure placed a greater urgency on HHS' insurer recruitment. He also said losing insur- ers like Aetna does not mean the exchanges are broken, but rather it is "the nature of the industry." 6. Aetna reported revenue of $15.95 billion in the sec- ond quarter of 2016, up 5 percent from the same peri- od of the year prior. The insurer recorded net income of $790.8 million, compared with net income of $731.8 million in the second quarter of 2015. Aetna record- ed revenue of $60.3 billion in 2015, up 4 percent from revenue of $57.9 billion the year prior. The insurer end- ed 2015 with net income of $2.4 billion, up 17.1 percent from net income of $2 billion in 2014. 7. Aetna shares closed at $120.55 after the compa- ny's letter to the DOJ was disclosed Aug. 17, up from $118.93 the day prior. Humana shares closed at $179.68 Aug. 17, changing little from $179.63 the day prior. n Patients Desert Texas' Costliest Hospital Following Pricing Report By Brooke Murphy T exas General Hospital in Grand Prairie may be struggling to attract patients for elective services aer a report named it the most costly hospital in the state, re- ports Dallas Observer. Last year, researchers from Johns Hopkins' Bloomberg School of Public Health in Bal- timore and Washington and Lee University in Lexington, Va., used Medicare data from 2012 to rank the 50 hospitals in the country that charge commercial insurers the greatest markups above Medicare rates. Texas General came in at No. 11, making it the hospital with the greatest markup price in the state, accord- ing to the report. e report found U.S. hospitals on average charged 3.4 times the Medicare-allowable cost in 2012. e top 50 hospitals named in Johns Hopkins' report charged an average of more than 10 times the allowable cost. Hasan Hashmi, MD, with Texas General told Dallas Observer that despite the hospi- tal's high rates, private insurers are responsi- ble for most of the hospital's income. "Most of our money still comes from the sporadic payments of commercial insurances," said Dr. Hashmi, though the hospital is considered out-of-network by most Texas health plans, according to the article. e high insurance rates are passed on to pa- tients that receive out-of-network treatment at the hospital, a practice commonly known as balance billing. Patients confronted with high charge rates typically choose to receive care at an in-network facility, where they share costs with their insurer. Yet Dr. Hashmi told Dallas Observer for-prof- it Texas General does not employ aggressive collection tactics to fulfill patient accounts. Instead, he said Texas General's rates have got- ten so high because the hospital does not take steps to collect payments from patients. n