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The Daily Tar Heel

Aetna and United Healthcare to leave state Affordable Care Act exchange

Blue Cross Blue Shield will be the only health care option for most N.C. residents in 2017

North Carolinians buying health care from the state's Affordable Care Act marketplace will have fewer choices next year after two providers, Aetna and United Healthcare, opt out of the exchanges. 

The two companies, which issued plans in the state’s Affordable Care Act exchanges during the last enrollment period, will leave North Carolina’s marketplace in 2017. United Healthcare announced its decision in April while Aetna’s decision came during August.

These decisions mean that most of the 613,487 North Carolina residents who buy health insurance from the state’s Affordable Care Act exchange will have to turn to Blue Cross Blue Shield when open enrollment begins in November. 

Insurers have been losing money from the Affordable Care Act marketplaces in North Carolina as well as in other states, Aetna CEO Mark Bertolini said in a statement. 

He said Aetna’s losses in Affordable Care Act exchanges nationwide, over $430 million since 2014, led to the decision for Aetna to leave North Carolina and 10 other states in 2017. 

Insurance companies are losing money in the exchanges because of the high level of risk in the applicant pool, said Jonathan Oberlander, the chairperson of the Social Medicine department at the UNC School of Medicine. 

“It is by definition a new market,” he said. “The risk pools on those marketplaces are more expensive than they anticipated.”

As a result, Aetna and Blue Cross Blue Shield both requested higher insurance premiums in order to combat losses from marketplace participation. 

Blue Cross Blue Shield is still deciding whether it will remain in the marketplace, according to a company press release. 

Blue Cross Blue Shield is the only insurer continuing to provide Affordable Care Act coverage in all 100 counties. Cigna will offer plans only for residents in certain parts of Wake County. 

North Carolina Insurance Commissioner Wayne Goodwin said in a press release that he was shocked and disappointed by Aetna’s decision to withdraw from the exchanges. 

“I am angered by the impact Aetna’s decision will have on Tar Heel families and our market,” he said.

While Oberlander said he believes Blue Cross Blue Shield will remain, he also said North Carolina needs to take steps to address the problems with the exchanges — starting with Medicaid expansion.

“With the stroke of a pen, we could cover a couple hundred thousand North Carolinians,” he said. “That would be good for those folks, it would be good for the state economy and it would bring federal money into the state.”

In the meantime, a marketplace with fewer options will hurt consumers, Oberlander said.

“It means less choice in terms of insurance plans — and if it stays this way, it’s going to mean, in the long run, likely higher premiums,” he said. “There are tens of thousands of North Carolinians whose insurance is going to be disrupted because Aetna and United Healthcare pulled out.”

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