Aetna left the ACA market at the beginning of 2026, citing underperformance. Other insurers have also been navigating a rocky ACA landscape, marked by the expiration of enhanced premium subsidies and shifting risk-pool dynamics.
CVS Health previously recorded a $448 million premium deficiency reserve in the first quarter of 2025 for its individual exchange business related to expected losses that year. During that quarter’s earnings call, former CFO Tom Cowhey had projected losses for the individual exchange business between $350 million and $400 million for full-year 2025.
Aetna CFO Andreana Santangelo recently joined the Becker’s 5th Annual Fall Payer Issues Roundtable and shared more about the decision.
“Very early on, you could see that we just didn’t have the right cost structure for our ACA business,” she said.
Citing her experience at a Blues plan and at Cigna, Ms. Santangelo said considerations around scale and cost structure are especially important for that business line.
While addressing how scale can be about more than sheer numbers, Ms. Santangelo said that “scale is also about having the right kind of risk pool” and attracting the right people who will find value in the product.
“Can we have a right to win and offer something that we feel good about having a sustainable future for?” she said.
More broadly, Aetna has been working on margin recovery over the past two years, particularly focusing on Medicare Advantage through 2027. Ms. Santangelo encouraged bigger-picture thinking when considering a company’s finances, though.
“People like to think of one-year increments in healthcare, and that makes sense. We have our annual call letter, we have the annual renewals. It seems logical to think about one year, but I think that’s short-sighted, and we really need a five-year outlook,” she said. “Now, what’s tricky about that is you revisit it every year to look at those five years because it does not stay static, but it gives you something to aim for.”
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
