On March 21st, 2016, an unprecendented coalition of major consumer groups and unions composed of Consumer Action, Consumers Union, Citizen Action of Wisconsin, SEIU Healthcare Wisconsin, Consumer Federation of America, US PIRG, WISPIRG, Wisconsin Jobs Now, Coalition of Wisconsin Aging Groups, Wisconsin AFL-CIO, ABC for Health, Wisconsin Federation of Nurses and Health Professionals, American Federation of State, County and Municipal Employees (AFSCME), National Association of Social Workers, Wisconsin Chapter, 9to5 Association of Working Women, Wisconsin, Wisconsin Farmers Alliance, and the National Alliance on Mental Illness Wisconsin filed comments to Wisconsin Insurance Commissioner Ted Nickel regarding the proposed merger of Aetna-Humana. The purpose of these comments was to raise concerns about the merger and its impact on healthcare in Wisconsin and to commend the Office for agreeing to hold a public hearing to evaluate the merger. Here are a number of specific points raised:
Under Wisconsin law, the Office of the Commissioner of Insurance (OCI), after a public hearing, is empowered to disapprove any insurance mergers, especially if they will substantially lessen competition or tend to create a monopoly.
The Aetna-Humana merger is a prima facie violation in the administrative-services-only (ASO) market and the Medicare Part D market.
A combination of Aetna and Humana would result in an entity with over a 10% market share of the Wisconsin ASO market. When combined with the new Anthem-Cigna merger, the two companies would service 61.6% of all ASO business.
The merger will raise competition in the Medicare Part D markets in several metropolitan areas. It would also put an end to what could be significant existing and future competition between Aetna and Humana in Medicare Advantage.
Wisconsin consumers need assurances that certain improper business practices by Humana will be addressed if it is acquired by Aetna. Recently CMS fined Humana $3.1 million for delaying or denying coverage to elderly patients.
The merger could lead to higher consumer costs and premiums in Wisconsin. Average individual premiums are steadily increasing, and there is substantial evidence that mergers lead to higher costs.
There are significant concerns that the mergers could affect network adequacy, and greater efficiencies are unlikely to result from these mergers.
Divestitures are not an effective remedy for health insurance mergers. However, OCI has the power to craft other remedies to protect consumers.
To see the full comments submitted to Commissioner Nickel please click here.
To see the comments submitted by the American Hospital Association to Commissioner Nickel, please click here.
To see the comments submitted by State Senator Dave Hansen and State Representative Erich Genrich to Commissioner Nickel please click here.
The Wisconsin Office of the Commissioner of Insurance approved the Aetna-Humana merger on April 15th, 2016.