Aetna exits AHIP; who’s next?

by Tracey Walker

Source: ManagedHealthcareExecutive

Aetna’s exit from the industry’s largest trade group, America’s Health Insurance Plans (AHIP), has industry watchers talking about what it means and who may be next.

Aetna follows on the heels of UnitedHealth Group, which left AHIP at the end of June. AHIP's members include 200 of the leading health plan and insurance companies.

In a company statement, Aetna said: “Aetna has decided not to renew our AHIP membership for 2016.  We will continue to partner with groups that are working, as we are, toward expanding access to high-quality, affordable healthcare.”

Aetna’s decision to leave AHIP is not surprising, given UnitedHealth’s decision to leave the trade organization last year, says Bill Stinneford, senior vice president at Buxton, a consumer analytics company that works with healthcare providers.

“The statements both companies made suggest that they feel their primary concerns no longer align with AHIP’s, justifying the decision to leave,” Stinneford says. “Given the proposed Aetna and Humana merger, it would not be surprising if Humana is the next major insurer to elect to leave AHIP.”

Marty Hauser, former CEO, SummaCare, and now partner, Chandler Group, agrees. "Assuming the Aetna-Humana merger is approved, it would probably not make sense for Aetna to maintain two memberships so it remains to be seen whether they maintain a membership once the merger is finalized," Hauser says.

John R. Graham, senior fellow, at the National Center for Policy Analysis, believes that the industry is seeing a collapse of consensus among health insurers.

“Each has a big decision to make about how they respond to health reform: Dig their heels in to defend Obamacare; or get onboard repealing and replacing it?” Graham says. “It is not an easy business decision. On the one hand, they won strong bipartisan agreement on a one-year moratorium on the health insurance fee [in the tax extenders/omnibus last December] and they can be optimistic they can keep rolling it over every year.”

On the other hand, Graham says, they are losing money in the exchanges and there is no bail out. “Are they willing to just exit the exchanges and write off 10 million customers? Other lines of business are doing well: Medicare Advantage and Medicaid managed care are thriving, so some insurers will decide just to give up on Obamacare itself. Others will do what they can to rescue the exchanges, but that will be a heavy lift.

“The industry thought Obamacare was a done deal, and it is not,” Graham continues. “So, it is not surprising to see them unravel with respect to the next steps. It provides a great opportunity for new ideas for health reform to get a hearing without running into the protective wall the insurers had built around Obamacare.

In the ever-changing healthcare industry and in light of Aetna's recent departure from AHIP, some have asked: Is a trade association still relevant?

Brill and Stinneford believe they are.

“But we should not be surprised if we see splintering and the rise of new organizations that better represent the goals and objectives of the sponsoring entities who, too, are seeking value,” Brill says.

“Trade organizations were designed in part to provide a united front for organizations within an industry. What we are seeing today, however, is a bifurcation in the health insurance industry,” Stinneford says. “The number of small, regional, nonprofit health insurance providers is growing, while the largest players are consolidating and becoming even bigger. AHIP and other trade organizations are certainly still relevant today, but they are most critical to the smaller organizations whose businesses are narrowly focused on health insurance and who do not have the resources to effectively lobby on their own.”

Companies such as Aetna, who have diversified into other aspects of healthcare and have the resources to be a powerful lobbying force in their own right, may prefer to represent themselves in order to more accurately present their agenda, Stinneford points out.

Courtney Jay, AHIP’s deputy director of media relations, says that last year, the Board began a process to propose and implement changes to AHIP's governance and dues structure in order to increase and maximize AHIP's advocacy work on the industry's key priorities.

Most recently, AHIP's advocacy led to significant cost-savings to consumers and regulatory successes for its members, including health insurance tax, market stability, health plan mergers, Medicare Advantage, King v. Burwell, drug prices, and Medicaid.

“In addition, AHIP will be launching an extensive Medicaid advocacy agenda in 2016 to address implementation issues and managed care expansion,” Jay says.

Following the news of Aetna's departure, Marilyn Tavenner, AHIP president and CEO, said in a statement: "AHIP's successful advocacy record speaks for itself. Our members depend on AHIP to advance their key priorities, to strengthen the public-private programs that provide coverage for millions of Americans, and to deliver solutions that improve access to high quality, affordable care for consumers.”

Managed Healthcare Executive Editorial Advisor Joel Brill, chief medical officer at Predictive Health, says that 2016 will be a tumultuous year for health insurers, who are preparing for the expiration of the Affordable Care Act's (ACA) reinsurance and risk corridor programs.

“Expiration of these programs will increase financial instability for insurers in the ACA marketplaces,” Brill says. “If losses on the exchanges go unpaid, carriers will be prompted to raise premiums or face solvency concerns and exit the market altogether. We expect that plans will be working to maximize their risk adjustment scores, which directly impact revenues.”

Viewed from these perspectives, the company’s statement that it would “continue to partner with other groups in the interest of expanding access to high-quality, affordable healthcare” speaks to how consumerism will increasingly guide patients who will seek value as they spend their, not the insurer’s, dollars for healthcare services, according to Brill.

Hauser believes that it has become an industry trend not just in healthcare, but in many industries, for organizations to periodically assess the value of participating in various types of membership organizations, including trade associations, given increasing pressure and scrutiny on expenses.

"It is also not unusual, given Aetna’s size, that they might choose to develop their own specific strategy related to lobbying and government relations based on their unique, specific priorities rather than depend solely on the often broader-based priorities of a trade association," he says.

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