Millions of Americans rely on Obamacare for health insurance since President Barack Obama signed it into law March 23, 2010.

Officially known as the Affordable Care Act (ACA), Obamacare has progressed over the years - but not without challenges.

In the beginning, the ACA saw some opposition from lawmakers in Washington, D.C., in an effort to overturn or repeal the 1,000-page health care plan since it was unveiled in July 2009.

In 2011, a Florida judge ruled that portions of the ACA were unconstitutional.

Also that same year, the Supreme Court began hearing arguments brought by 26 states and the National Federation of Independent Business, which claimed elements of the ACA were unconstitutional.

Now in its sixth year, the ACA faces its latest challenge, a decline in health insurance companies on the health care exchanges in Alaska, Arizona, Colorado, District of Columbia, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan. Montana, Nevada, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah and Wyoming.

Recently, Aetna, one of the country’s largest health insurance companies, has followed UnitedHealth Group and Humana in announcing it will also pull out of the health exchange at the end of 2016.

Aetna Chairman and CEO Mark T. Bertolini in an Aug. 15 press release titled “Aetna to Narrow Individual Public Exchange Participation,” stated, “Aetna will reduce its individual public exchange participation from 778 to 242 counties for the 2017 plan year, maintaining an on-exchange presence in Delaware, Iowa, Nebraska and Virginia.”

According to Bertolini, Aetna is a strong supporter of the health care exchange, and the company regretted having to make the decision to pull out.

“Following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax loss of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward,” Bertolini stated. “Fifty-five percent of our individual on-exchange membership is new in 2016, and in the second quarter we saw individuals in need of high-cost care represent an even larger share of our on-exchange population.”

According to the article “Insurer ACA Exchange Participation Declines in 2016,” dated March 14, “While the participation level in 2016 is greater than the 253 insurers that offered exchange coverage in 2014, the figures for all three years are still below the 395 insurers that offered individual-market coverage in the 50 states and the District of Columbia in 2013, just prior to the ACA taking effect.”

There were 14 health insurers participating in the exchange in Pennsylvania in 2013 (pre-ACA), compared to seven in 2016.

With the recent announcements of UnitedHealth Group, Humana and Aetna pulling out, Lehigh Valley residents will only have four insurance companies - Capital BlueCross, Geisinger, Highmark Health Insurance Company and Keystone Health Plan Central, a Capital BlueCross Company - to choose from through the health marketplace exchange in 2017.

What will this latest challenge mean for the ACA and insuring Americans in the future?

Will we see higher premium costs in 2017 as there are fewer insurance company choices on the health care exchange?

The ACA has been resilient with all the challenges it has faced until now. Only time will tell if it is able to survive this latest challenge and continue to insure the millions of Americans who rely on it for health insurance coverage.

Susan Bryant

editorial assistant

Parkland Press

Northwestern Press