Who Wins And Who Loses When The Fate Of The Aetna-Humana Deal Is Decided?

The Aetna Inc AET and Humana Inc HUM deal hangs in limbo as John Bates, the Federal Judge appointed to oversee the case is yet to give a timeline for the final ruling even after the final hearing is over. The deadline, which has been pushed forward twice, now looms large, with February 15 less than a month away.

Amid this uncertainty, Benzinga looked at the winners and losers of the tug-of-war between the companies concerned and the Department of Justice.

Presuming The Deal Goes Through:

Winners

• Aetna's share of the state and federal funded Medicaid program and Tricare coverage for military personnel and their families is seen to increase notably.
• Estimates suggest that Aetna would see its Medicare Advantage business nearly triple.
• However, Aetna has argued that separating Medicare and Medicare Advantage is not right. If both are considered as one market, a Aetna-Humana combination will only be left with an insignificant share of the overall market.
• Over time, medical providers would have easier access to patient's medical records and billings options.

Losers

• At least according to arguments placed by consumer rights advocacy groups, low-to-moderate income families could be affected. Reduced competition would mean limited choice to choose from different plans.
• The DoJ had contended in its lawsuit that elimination of competition would reduce choices, resulting in higher premiums for consumers, many of whom could not afford health insurance purchased off exchanges.
• The DoJ also sees taxpayers getting affected, as higher amount of financial assistance offered through the public exchanges come at the expense of the taxpayers' money.
• The DoJ had placed its stiff opposition on two grounds. 1) It would create monopolies or near monopolies in Medicare Advantage markets. 2) It would scale down competition in 17 counties on the Affordable Care Act exchanges.
• Seniors may be affected, as diminished competition could mean companies getting away with less generous services.
• Doctors fear that they will be eliminated from networks, out-of-network co-payments could increase and access to services may be denied.