Max Nisen is a Bloomberg Gadfly columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.

Aetna's announcement on Tuesday that it expects to lose money on Obamacare's individual health-insurance exchanges and won't expand its participation next year makes a worrisome five for five: All of the biggest U.S. health insurers now expect such losses. 

No ACA? No Problem
Aetna still made money despite problems with its Obamacare business, and shares are up.
Source: Bloomberg
Intraday times are displayed in ET.

Aetna had previously expected to participate in five more state exchanges and at least break even on the Affordable Care Act this year. Its downgraded view comes on the heels of Anthem's revelation last week that it also no longer expects to break even or profit on Obamacare, along with a warning of "prudent" decisions about continued broad participation in the program.

Back when UnitedHealth was the only insurance company bailing out, it was easy to dismiss as just one company trying to boost its bottom line. But when all five big insurers are bleeding money, it's clear you've got bigger problems. 

Rough Sledding
It's been a tough 2016 for big insurers participating in Obamacare.
Source: Bloomberg, Companies
*Figure as of Q1. Other numbers are from Q2.

When UnitedHealth outlined its ACA concerns last November, both Anthem and Aetna were still projecting optimism about the exchanges. The first two quarters of this year have dashed their hopes. People buying health insurance on the exchanges have been spending more money on health care and drugs than expected, and insurers are afraid that won't improve. 

A less-charitable interpretation of some insurers' sudden increased aversion to Obamacare is that they are reacting to the Department of Justice's efforts to block mega-mergers between Anthem and Cigna and Aetna and Humana. The firms could be playing hardball, using the specter of withdrawing from the exchanges as a bargaining chip. And in the absence of the big revenue and scale boosts these mergers would provide, sticking around and losing money in Obamacare may look even less attractive. 

In any case, these companies are capable of weathering the storm. Even with its Obamacare difficulties, Aetna's adjusted net income for the quarter grow 8 percent year-over-year to $791 million. And many of the ACA issues are resolvable. For example, Aetna noted the government's risk-adjustment mechanism doesn't include drugs, which drive a large amount of spending.

But the prospect of hemorrhaging money for an indeterminate period isn't much of an incentive for drugmakers to wait for a fix. 

This column does not necessarily reflect the opinion of Bloomberg LP and its owners.

To contact the author of this story:
Max Nisen in New York at

To contact the editor responsible for this story:
Mark Gongloff at