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The public emergence of the bluntly worded letter, from Aetna’s Chief Executive Mark T. Bertolini, has led critics to question the motives behind the insurance company’s recently disclosed pullback from the insurance exchanges. It also has added a layer to a broader debate over the causes and cures for the red ink the exchanges are generating for insurers. (Wilde Mathews and Armour, 8/17)

The big health care news this week came from Aetna, which announced on Monday it was dramatically scaling back participation in the Affordable Care Act ― thereby reducing insurer competition and forcing customers scattered across 11 states to find different sources of coverage next year. ... the move also was directly related to a Department of Justice decision to block the insurer’s potentially lucrative merger with Humana, according to a letter from Aetna’s CEO obtained by The Huffington Post. (Cohn and Young, 8/17)

In the July 5 letter, Aetna Chief Executive Officer Mark Bertolini said it would have to cut back because it would be some time before the company recouped the investment it had made in this market over the past 2-1/2 years. "Our ability to withstand these losses is dependent on our achieving anticipated synergies in the Humana acquisition," Bertolini wrote. (Humer, 8/17)

Rep. Frank Pallone Jr. (N.J.), ranking Democrat on the Energy and Commerce Committee, issued a statement Tuesday saying he was "troubled by reports this announcement could be in retaliation" to the Justice Department's decision. Earlier this month, after Aetna announced in an earnings call this month that it was reevaluating its participation in the exchanges, Sen. Elizabeth Warren (D-Mass.) wrote on Facebook: "The health of the American people should not be used as bargaining chips to force the government to bend to one giant company’s will." (Johnson, 8/17)

The change in tack for Aetna is also noteworthy because Bertolini was talking up the business potential of the exchanges as recently as April, when he said during a call with analysts and investors that the exchanges were "a good investment," despite the losses incurred. At the time, Bertolini said that Aetna was "committed to working constructively with the administration and lawmakers to find solutions that can improve this program, stabilize the risk pool, and expand product flexibility, all with the goal of creating a sustainable program that makes health care more affordable and accessible for all consumers." Now, the company appears to be taking its ball and going home. (Hensley, 8/17)

The trend of health insurers pulling back from public exchanges raises concern for the future of the Affordable Care Act. It is far less of a worry for investors. Aetna announced plans earlier this week to withdraw from 11 of the 15 states in which the insurer currently offers public exchange plans to individuals. ... Regardless of motivation, Aetna has chosen to exit an unprofitable business. The company said it lost $200 million in pretax income from the exchange business in the second quarter and expects to lose more than $300 million this year. (Grant, 8/17)