The health insurance industry at the Wynn this summer, the ritziest casino hotel in Las Vegas. Busy guys going from one seminar to another seminar brainstorming new schemes to improve health care quality for members while keeping patients away from providers in order to reduce utilization.

Aetna wants to merge with Humana this year. It’s just fine with the Ohio Department of Insurance, even though Ohio legislators and consumer groups requested to first have an investigation and public hearings about the merger. See this letter, and this article. Thankfully, the U.S. Department of Justice may put a stop to it; the DOJ filed a lawsuit on July 21 and will conduct an investigation. The Ohio Attorney General is joining in with the DOJ to challenge the merger, in an interesting turn of events.

Aetna, whose CEO made 15.1 million in 2014, broke off with the health insurance lobbying group AHIP this year, because they are so darn big. Aetna has 23,670,000 medical health insurance members. Humana, (whose CEO made 10.2 million in 2014), has about 10 million members with an additional 4.4 million Medicare members. Together, they would have 38.07 million members, which is about half the total number of Americans on Medicaid.

Aetna’s stock went up 525% in the past seven years.

Aetna is asking for a rate hike of 12.97% average, ranging from 7.9% to 22.7% for their PPO PD (pediatric dental) plans, and an 11.37% average increase, ranging from 3.3% to 22.8% increases for their PPO plans.

Humana is asking for a 39.3% rate increase, ranging from 20.6% to 42.3% increases. Humana services the Dayton and Cincinnati areas, and will affect 5,178 individuals. (Which is about half the total number of individuals in Toledo who buy any plan on the Marketplace.)

Humana is estimating the combined cost and utilization trend to be 7.7% annually, or 16.1% for two years.

Aetna expects medical costs to go up 7.6%, because providers raised their prices and members get more medical care. Aetna expects drug prices to go up by 10%.

Aetna has 20,771 members in the state of Ohio, which is about 8% of the market, and 660 members in Area 1, which includes Toledo. It expects to gain 152 more members from Area 1 in 2017.

The average age of the membership is 50.

Aetna projects an average premium of $451.82, with an index rate of 488.68 before the age factor is applied.

The Aetna product with the pediatric dental will be going up an average of 2.4% more than the plan without, so families with kids will get hit harder with rate increases. Clever. 15% of the covered members are 21 or younger, however 25% buy the plan with pediatric dental.

If you can afford it, you may be one of the lucky few who can actually keep their doctor, since Aetna claims to have the biggest of all Toledo provider networks.

This year Aetna serves as the second lowest cost silver plan in Rating Area 13, which is Youngstown, where it insures about 2,200 people.

Insurance regulators, reject unreasonable, unsustainable rate hikes. Please have some understanding of our economy.

WAIT! –– AETNA HAS PULLED OUT, JUST THIS AUGUST 16! In what appears to be a knee-jerk reaction to the DOJ investigation, but they say it’s over the high price of drugs! What a giant corporate bully!  The “smoking gun”

Can you imagine if you were to do it, in your small business, suddenly back out of a contract and long-time commitments, how weird and unprofessional that would be, and here we have hundreds of thousands of individuals in 11 states affected by this –– what is going on?


LA TIMES January 23, 2017: U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare