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The nation's third largest health insurer is painting a cloudy picture of its future on the Affordable Care Act's insurance exchanges. Aetna Chairman and CEO Mark Bertolini said Tuesday that his company will announce by April 1 whether it plans to stay beyond this year in any of the four states where it currently sells coverage, and it's "really impossible to consider entering any new markets." "We have nothing but bad news in front of us right now," he told The Associated Press. (1/31)

Bertolini said in an interview that the insurer wouldn’t expand its presence in the Affordable Care Act’s exchanges for 2018 and was re-evaluating its current footprint for next year. He said that Aetna had spoken with Capitol Hill officials and Trump transition representatives and that it is “too soon to tell” what will result from the Republican overhaul of the ACA, which he said he thought would take effect “at the earliest” in 2019. He said that “everybody is very concerned about doing something rash that would blow the thing up and put people out of coverage.” (Wilde Mathews and Jamerson, 1/31)

National insurer Aetna has no plans to re-enter the ACA exchanges in any of the 11 states it exited earlier this year. That's despite the public scolding Aetna received earlier this month from a federal judge who concluded that Aetna pulled out of the exchanges to improve the chances of closing its merger with Humana, and that it wasn't a business decision related to financial losses. Instead, the Hartford, Conn.-based insurer will continue to evaluate its 2018 participation in the four states where it currently sells exchange plans. (Livingston, 1/31)

His remarks are an early sign of how the debate over how to repeal and replace the Affordable Care Act may affect the health law’s markets. The sales period for 2017 health plans ends today, and insurers are already crafting the plans they’ll begin selling in the fall for 2018. Congressional Republicans, who’ve been disagreeing on how to replace the law, have said they’re aiming to present plans for a replacement in March or April. (Tracer, 1/31)

House Minority Whip Steny Hoyer, D-Md., disputed Bertolini’s comments and said they make defense of the ACA more difficult. Hoyer said the Trump administration and Republicans are creating the uncertainty Bertolini says is hurting insurers. “In other words, the chaos and uncertainty that this administration has created over the last 10 days has led to the very thing that they say is the problem – and that is insurers are not confident in the ACA,” Hoyer said. (Radelat, 1/31)

Aetna had about 965,000 people covered by individual policies at year’s end, and this year, after withdrawing from most of the places it had been selling, it expects to have 240,000 individual customers, with 190,000 of them on the Obamacare exchanges. (Lee, 1/31)