Insurance companies keep pretending that participating in the Affordable Care Act exchanges is killing their business model. Aetna, one of the five largest insurance companies in the United States, announced on Tuesday that it was withdrawing from 70% of the Obamacare exchange markets it operates in by next year. And two other major insurers – UnitedHealthCare and Humana – also announced recently that they would be withdrawing their products from large portions of the exchanges where they’re available.



Obamacare isn't perfect, but it's a start – and it's better than the nothing we had | Liz Seegert Read more

But this corporate hardship story couldn’t be further from the truth: Aetna’s overall profits surged last year, and its share prices have risen consistently since the ACA passed in 2010.

All the other major insurance companies have noted similar rises, even as the product that they offer has been deteriorating. Premiums have long outpaced wage increases and underinsurance is rife even among those with insurance.



So while staying wouldn’t have drastically endangered their bottom lines, the decision may, however, cause uninsured Americans looking for Affordable Care Act coverage have even fewer subpar options to pick from. One county in Arizona is slated to not have a single option available next year. These withdrawals could hurt Americans and the ACA in a way Republicans have only dreamed of.

If business is booming, why penalize Americans seeking healthcare? The picture becomes clearer when looking at the state of the health insurance industry at large. In short: politics.

The past few years have seen unprecedented consolidation between insurance companies as they’ve merged and become behemoths. In an endless quest to have unlimited negotiating power, insurance companies big and small have been joining together. The big five – Aetna, Anthem, Cigna, Humana and UnitedHealthCare – now control a disproportionate chunk of the market. Most recently, Aetna and Humana announced a bid to merge, threatening to make the American health insurance market even more uncompetitive. The justice department filed suit to block it.

It’s possible, then, that the mass withdrawal from ACA participation is a political chess move. Or, as Elizabeth Warren wrote in a Facebook post last week: “The health of the American people should not be used as bargaining chips to force the government to bend to one giant company’s will.”

Aetna and Humana’s holdout from the exchanges is further evidence of just how important it is to hold them accountable, particularly since recent data shows that the risk levels of patients enrolling in the exchanges was starting to slow. (One of the excuses companies used to walk away from the exchanges was that they didn’t budget for the large percentage of sick Americans, rather than a mix of sick and well, who rushed to sign up when the ACA’s ban on discriminating against pre-existing conditions went into effect.) Insurance companies aren’t the only ones out to give Americans a raw deal: in an analysis I published recently in the New England Journal of Medicine, I detailed how an inability to negotiate prices effectively with pharmaceutical companies could bankrupt Medicare.

But the fact is, insurance companies want to have their cake and eat it too. They love the ACA when enrolling young, low-risk people who would otherwise be penalized for not having insurance. But they want to deny care to patients who are actually sick and need the coverage. Watching their advertisements on television, it is easy to be lulled into thinking that all health insurance companies care about is the health and wellness of ordinary Americans, but we’re really just entries on an accounting sheet.

These attempts to weaken the ACA need to be battled. An analysis I am in the process of publishing with my collaborator, Khurram Nasir, shows that the ACA reduced the number of uninsured Americans with heart disease by a fifth in just its first year of implementation.

Healthcare is a responsibility shared by many – physicians, hospitals, pharmaceutical companies, government agencies and patients – but we need to make sure that the unabated, unbridled, corporate ambitions of insurance companies are kept in check.