Obamacare is in a death spiral, Aetna CEO says

SAN FRANCISCO, CA - NOVEMBER 03:  Aetna chairman and CEO Mark Bertolini speaks during the Fortune Global Forum on November 3, 2015 in San Francisco, California. Business leaders are attending the Fortune Global Forum that runs through November 4.  (Photo by Justin Sullivan/Getty Images)

SAN FRANCISCO, CA - NOVEMBER 03: Aetna chairman and CEO Mark Bertolini speaks during the Fortune Global Forum on November 3, 2015 in San Francisco, California. Business leaders are attending the Fortune Global Forum that runs through November 4. (Photo by Justin Sullivan/Getty Images)

NEW YORK (CNNMoney) — Obamacare is in a “death spiral’ and more insurers will flee in 2018, Aetna CEO Mark Bertolini said Wednesday.

More sick Americans are flocking to the Obamacare exchanges, which is pushing insurers’ costs higher, Bertolini said at a Wall Street Journal forum. That, in turn, is forcing carriers to either abandon the market or raise their rates.

Bertolini’s comments come on the heels of Humana’s decision to pull out of the individual market completely in 2018, citing an inability to offer a “viable product.”

Aetna, meanwhile, is still evaluating whether it will remain in the four states where it currently operates, but it will “lose a lot of money in those markets this year,” said Bertolini. Anthem has also said it is reviewing its participation. Both insurers said they will announce their involvement in the spring.

Between 1% and 5% of Aetna’s customers account for 50% of its costs, depending on the market, Bertolini said. And in many places there is little competition and risk-sharing, he said, citing Nebraska, where Aetna is the only player.

“There isn’t enough money in the ACA today as it is structured — even with its fees and taxes — to support the population that needs to be served,” he said.

Talk of Obamacare being in a death spiral ramped up last year when Aetna and several other carriers decided to scale back their exposure to the exchanges after sustaining multimillion dollar losses. That left consumers in 70% of the nation’s counties with only one or two companies on the exchanges and became a major talking point for Republicans, who say the program is collapsing.

A death spiral occurs when consumers have fewer, more expensive choices, which prompts healthy people to exit, leaving an even sicker pool of policyholders in the exchanges. Eventually, all of the insurers withdraw.

Obamacare supporters have defended the law, saying it was going through an expected transition period that would only last a year. President Trump and Congressional Republicans have promised to repeal and replace the program, though they remain divided over how to do so.

Before the GOP can dismantle Obamacare, however, they have to stabilize it since it will take at least a year or two for their plan to take effect. Republicans have promised that Americans will not lose their coverage during the transition. The Trump administration Wednesday issued a proposed rule that would address some of insurers’ concerns in hopes of keeping them in the market while Republicans determine what to do.