Aetna hit with lawsuit over leaving ACA exchanges

Shareholders in the company claim that its exit from the exchanges was retaliation against the government, not a business decision

Aetna hit with lawsuit over leaving ACA exchanges

Insurance News

By Ryan Smith

Aetna has been sued by shareholders over its 2016 decision to reduce its participation in Obamacare insurance exchanges.

The lawsuit accuses Aetna’s board of breaching its fiduciary duties to the company and shareholders by lying about why the company pulled out of Affordable Care Act exchanges in 11 states.

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Modern Healthcare reports that the Allegheny County Employees’ Retirement Fund, which owns stock in Aetna, said that the insurer’s withdrawal wasn’t a business decision, as Aetna claimed, but a strategy to improve its chances in an ultimately failed $37 billion deal to acquire Humana.

According to the plaintiff’s complaint, Aetna’s true reasoning for the withdrawal came to light during the legal battle to make the planned merger a reality. The lawsuit claims that Aetna’s conduct hurt both the company’s reputation and its bottom line. The lawsuit claims that Aetna consciously chose to forego profits “simply to make good on their wrongful threats to the government.”

“The real reason that Aetna withdrew from the exchanges was to retaliate against the government for its attempt to block the Aetna-Humana merger, and, moreover, the public exchanges in multiple states from which Aetna actually withdrew were highly profitable to the company,” the lawsuit said.

The first accusation that Aetna tried to leverage its participation in the exchanges to its advantage in the merger came from the judge who blocked the union.

US District Court Judge John D. Bates claimed in his opinion on the merger case that Aetna’s leadership had made repeated threats to the Justice Department that it would withdraw, Modern Healthcare reported. Bates wrote that Aetna had made good on those threats.


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