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Mark Bertolini

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Aetna bailing out of all ACA exchanges


Aetna will complete its withdrawal from Affordable Care Act state insurance exchanges in 2018. The huge insurer, which overall is very profitable, said that continuing financial losses in the exchanges and uncertainty about the marketplaces’ future led it to decide to leave the last  two states  — Delaware and Nebraska — in which it has been on ACA exchanges. Just last week it said that it would stop offering ACA health plans in Virginia in 2018 and last month it  said it would leave Iowa.

Aetna Chief Executive Mark Bertolini has said that the ACA marketplaces were in a “death spiral,” which the nonpartisan Congressional Budget Office said isn’t true.

The exchanges have been undermined by the fierce opposition to the Affordable Care Act of the Trump administration and Republican politicians in Red States.

Insurers, for their part, complain that their ACA plans attract too few of the young and healthy customers needed to offset the expense of covering older people, who, of course, tend to have more serious  health problems than do younger people.

A major reason is that the financial penalties for people for not buying insurance are far too small.

For example, the penalty for not buying insurance for an adult is $625 per adult and $347.50 per child under 18. So a lot of younger healthy people decide to pay the fine, which is much cheaper than paying insurance premiums. And if they get sick or injured, they can go to a hospital ER, where all or some of the costs will be covered by the hospital, in the form of “charity care” and local, state and federal governments.

It’s all just another example of why  the U.S. healthcare system is near the bottom in medical outcomes and at the top in costs in the Developed World. It’s immensely complicated and contradictory, fee-driven and fueled by the desire of many, perhaps most, clinicians and hospital and insurance executives for maximum personal profit.

To read more, please hit this link.


Aetna to push community health


Aetna CEO Mark Bertolini, eager to cut his company’s costs, says the huge insurer will  invest in social programs to help the health of people in the long run. Aetna has been moving away from the Affordable Care Act’s insurance exchanges because it has found them inadequately profitable.

He says the ACA is flawed in that while it has opened access to coverage for millions of Americans, it doesn’t adequately address the role of community and behavioral health in reducing treatment of chronic illness, as do such things as encouraging healthy eating and exercise.

So, USNews & World Report says:

“Aetna is focusing its efforts on setting the blueprint for what it sees as the next step to health care reform under a new administration.

“Through research and grants the firm’s Aetna Foundation is investing in projects aimed at reducing chronic disease like expanding healthy eating options or constructing walkable neighborhoods. The company… intends to demonstrate that the quality of a person’s health has less to do with the health care they receive and more to do with how they live.

This got the attention of  those of us at Cambridge Management Group who have long worked in community health and have been addressing the social/behavioral causes of illness and how to address them.

To read the US News article, please hit this link.

Architects of insurance mega-merger plans


A look at Aetna chief executive Mark Bertolini, who has struck a $34 billion deal for Aetna to buy Humana, and Anthem CEO Joseph Swedish, who has a deal for Anthem to buy Cigna for $48 billion.


The merger plans won’t necessarily go smoothly: The Justice Department is leery of huge concurrent transactions in the managed-care industry. And hospital officials and physician groups, fearing cuts in their revenues because of the  new behemoth insurers’ bargaining power, oppose  the acquisitions. Further, two congressional committees have scheduled hearings for the fall on the mergers.

As The Wall Street Journal noted,  the “Aetna deal would create by far the biggest player in the private-insurer version of Medicare, so concern over market concentration will focus on the companies’ footprint in that business, known as Medicare Advantage. Mr. Bertolini said that the vast majority of Medicare Advantage consumers have at least five options currently, so ‘we don’t see a reduction in competition for consumers’ from the Humana deal.”

“He argues that the merged company will be better positioned to work closely with health-care providers and the federal government to bring down costs and improve quality.”






Jim Hightower: Aetna the insurance apostate

Business schools preach a strict, anti-social doctrine of corporate management that comes down to this: CEO’s must be idiots.

By that I mean the original Greek word idiotes, which applied to people who care only about themselves and the prosperity of their immediate family. They’re the ones who reject any responsibility to the larger society, civic affairs, and the common good.

That selfish ethos is what prevails in today’s corporate suites, where it’s claimed that the only responsibility of executives is to maximize profits for the “family” — that is, for themselves and their major shareholders.

If they have to stiff workers, sidestep environmental rules, and shaft consumers to do it, well, that’s the lot of idiotes.

But now comes an apostate to this doctrinal idiocy.

Mark Bertolini,  chief executive of the Hartford-based health-insurance giant Aetna, says CEO’s should raise the minimum wage their companies pay to a level approaching minimal fairness. Rather than just calling for it, though, he actually did it. He lifted Aetna’s lowest wage to $16 an hour, plus improved health benefits.

Then Bertolini really gave up the game: He publicly revealed that these increases aren’t so financially painful after all.

The total cost to Aetna will be about $26 million a year. That’s nothing for a company with annual revenues of $62 billion.

The only pain that Bertolini might feel is loneliness when he enters the CEO Club and sees other insurance chieftains turn their backs and shun him over his leadership on the moral matter of shared prosperity.

Indeed, the CEO’s of Humana, Anthem and other insurers say “no” to raises for their employees, sniffing that they pay “competitive wages” — which is just a dishonest way of saying “low wages.”

Whether those idiotes like it or not, Aetna just lifted the national standard for competitive wages.

Moreover, the insurer has thrown open the doors of the executive suites to an honest public conversation about the morality of the suits inside jacking up their compensation while holding down everyone else’s pay.

Jim Hightower is a columnist for, where this originated.

Execs say the ACA too entrenched to be killed




Top healthcare executives say that the Affordable Care Act is far too entrenched to be killed  by Republicans on Capitol Hill.

Repeal of the ACA “is not a possibility,” George Scangos, chief executive at biotechnology company Biogen Idec Inc., told Reuters . “They {the Republicans} would somehow have to explain to millions of people that they will lose health insurance.”

Aetna Inc. said it is talking to Republicans and Democrats about a possible “grand bargain” to salvage  the ACA if the U.S.  Supreme Court rules against key elements of the law later this year.

“Blowing up the (Affordable Care Act) is like shutting down the government,” Aetna Chief Executive Officer Mark Bertolini told some investors. “So we are having conversations on both sides of the aisle about what … things you change in the ACA, what we could introduce, about how to make a grand bargain should the Supreme Court decide.”



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