Aetna's AHIP exit may be turning point for industry advocacy

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In the wake of Aetna's announcement that it would leave America's Health Insurance Plans, speculation has continued to swirl about what it means for the industry.

Aetna was the second major insurer to leave the health insurance sector's largest trade association, following UnitedHealth's exit this past summer.

Some think two insurers' decision to part ways with AHIP may herald a new chapter in which multiple trade associations and interest groups represent the insurance industry.

"We should not be surprised if we see splintering and the rise of new organizations that better represent the goals and objectives of the sponsoring entities who, too, are seeking value," Joel Brill, chief medical officer at Predictive Health, told Managed Healthcare Executive.

Major insurers also are increasingly advocating for themselves. Aetna and Cigna--both poised to merge with other insurers--together spent more than $1.3 million on outside lobbyists last year, the Connecticut Mirror reports. That's in addition to the $2 million and $3.5 million, respectively, that their in-house lobbying departments spent in the first nine months of 2015.

Insurers' struggles to make a profit on the Affordable Care Act exchanges may also be driving rifts within the industry, John R. Graham, a senior fellow at the National Center for Policy Analysis, told Managed Healthcare Executive. UnitedHealth, for example, has said it may leave the ACA marketplace in 2017 if its losses continue.

Insurers face a difficult business decision in whether to ride out the exchanges' volatility, Graham said, "so it is not surprising to see them unravel with respect to the next steps."

AHIP CEO Marilyn Tavenner, who replaced longtime leader Karen Ignagni in July, has defended the trade group's role in the industry, saying "AHIP's successful advocacy record speaks for itself," FierceHealthPayer reported. Tavenner brings considerable clout to the organization, as she previously served as administrator for the Centers for Medicare & Medicaid Services.

To learn more:
- read the Managed Healthcare Executive article
- here's the Connecticut Mirror report

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