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Judge cites “persuasive evidence” that Aetna withdrew from ACA exchanges to evade regulatory oversight

In a federal court decision that blocked its planned merger with Humana, health insurance giant Aetna was also called out for withdrawing from most Affordable Care Act exchanges in order to evade regulatory oversight.

U. S. District Judge John Bates wrote that there is “persuasive evidence” that Aetna left the Affordable Care Act exchanges in 17 counties from 11 states not “for business reasons, but instead to follow through on the threat that it made earlier,” according to CNN Money on Tuesday. The decision, Bates argued, was made “specifically to evade judicial scrutiny.”

The “threat” that Judge Bates referred to can be traced back to last summer. In July, the Department of Justice blocked a $ 34 billion merger that Aetna had planned with Humana because it claimed the move would violate antitrust laws. Prior to this decision, however, CEO Mark Bertolini wrote a letter to the Department of Justice warning that “it is very likely that we would need to leave the public exchange business entirely . . . should our deal ultimately be blocked.”

In August, the month after the Justice Department’s decision was made, Aetna officially left many of the Affordable Care Act exchanges. They claimed that this was a purely business decision, but after reviewing the Justice Department’s case (including internal emails within the company), Judge Bates concluded that this was in fact done so the company could “improve its litigation position.” As Bates wrote, “Aetna tried to leverage its participation in the exchange for favorable treatment.”

In response to Bates’ ruling, Bertolini and Humana CEO Bruce Broussard issued a joint statement saying the companies would “carefully consider all available options” for their future and that they “continue to believe a combined company will create access to higher-quality and more affordable care and deliver a better overall experience for those we serve.”

Matthew Rozsa

Matthew Rozsa is a breaking news writer for Salon. He holds an MA in History from Rutgers University-Newark and his work has appeared in Mic, Quartz and MSNBC.

Matthew Rozsa.

Source: Salon: in-depth news, politics, business, technology & culture > Politics

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