Aetna has announced that it will stop participating in the Iowa health insurance exchange in 2018, citing financial losses and market instability as primary reasons to exit.
Aetna also said it is reviewing its presence in other states, including Nebraska. Aetna pulled out of most of the markets where it sold exchange plans a year ago, and its chief executive has described the marketplace as in a "death spiral". Only one other insurer, the relatively small Minnesota carrier Medica, now sells individual policies in most Iowa counties. The Iowa Insurance Division said 18,900 of those bought policies off the exchange while 2,500 purchased in the exchange.
"We are still developing our 2018 strategy and have not yet made final decisions", said Greg Bury, a Medica spokesman, on Tuesday.
Insurers have complained that the Affordable Care Act, also known as Obamacare, put them in a hard spot.
Other insurers that have pulled back from the marketplace include Humana, which is exiting all ACA exchanges after this year, and Blue Cross and Blue Shield plans.
The decisions will sharply curtail choices for Iowans who want to buy insurance plans that could qualify for federal subsidies under the Affordable Care Act.
Many have asked the government to extend the subsidies for 2018. For months, health insurers have threatened to quit offering policies on the ACA's marketplace if they don't get the regulatory details they need to design and price their insurance plans. Medica serves about 14,000 members both on and off the exchanges in Iowa.
But the amendment to the stalled American Health Care Act, called the Federal Invisible Risk Sharing Program, does not say how that money would be distributed, leaving that to the Department of Health and Human Services.
Wellmark's departure was quickly seized on by the Trump administration as evidence that the exchanges were failing and that the Affordable Care Act needed to be repealed.
Aetna's withdrawal could impact more than 35,000 people.