AET Aetna Inc. (delisted)

By Laura Meckler 

WASHINGTON -- Aetna Inc.'s decision to scale back participation in the Affordable Care Act's exchanges is putting new pressure on Hillary Clinton over health care, a onetime signature issue that has taken a back seat in her presidential campaign.

The pressure is coming from the right but also the left. Liberals say the Aetna decision shows the need for a government-run option to compete with the private insurance companies, or even for a single-payer, Medicare-for-all program, as Sen. Bernie Sanders proposed again this week.

"The provision of health care cannot continue to be dependent upon the whims and market projections of large private insurance companies whose only goal is to make as much profit as possible," Mr. Sanders said in a statement. The message to Mrs. Clinton, an aide said, was that the Vermont senator would continue to pressure her on the issue if she's elected president.

Democrats have tried to move past debate over the Affordable Care Act, a goal made harder this week when Aetna said it would withdraw from 11 of the 15 state health care exchanges, unsettling the marketplaces and reducing consumer options.

Mrs. Clinton has backed a public option since 2007, and she reaffirmed her support during her Democratic primary against Mr. Sanders. He and others on the left will be pushing to make sure she carries through, especially given their concerns that she will tack to the center if elected president.

Conservatives, meanwhile, say Aetna's decision shows the law isn't working and should be scrapped.

"Aetna just today announced that they are dropping out, as are many of the major insurance agencies. Obamacare is a disaster," Republican presidential nominee Donald Trump said at a rally late Tuesday in Wisconsin.

Mr. Trump has also talked repeatedly about premium increases expected this fall, a related issue that also is problematic for the health-care exchanges. He routinely predicts that the spikes will be "election changing." He also accuses the Obama administration of plotting to delay the announcement of the increases until after the elections.

"Premiums are going up at a rate that nobody has ever seen before," he said last week in Virginia. He predicted the fall hikes will be "catastrophic...an increase like never before."

At the start of the campaign, Mrs. Clinton outlined a suite of proposals aimed at addressing the high costs of health care, for instance, new limits on out-of-pocket costs. But she said little about the structure or future of the law itself.

"She was hoping we had just moved beyond a fight on the ACA," said Neera Tanden, president of the Center for American Progress and a longtime Clinton policy adviser.

In their primary, Mr. Sanders aggressively challenged her on health care, saying a "Medicare-for-all" single-payer plan was the only way to guarantee universal coverage. In February, the Clinton campaign quietly added to her website a statement supporting the public option. She hardly mentioned the matter until July, when she reaffirmed her position after talks to win Mr. Sanders's endorsement.

Clinton advisers say her support for the idea is genuine. In an economic speech last week, she promised to "defend and improve" the health law, including "giving Americans, in every state, a choice of a public option health insurance plan that will help everybody afford coverage."

"It will strengthen competition, and drive down costs," she said.

Aides say Mrs. Clinton's hope is that if elected, she will be able to work with Republicans to improve the law. Chris Jennings, an outside adviser to the campaign, cited ideas aimed at increasing enrollment as areas where she hopes to work with the GOP.

"People on all sides of this issue need to ratchet back the politics in health care and reflect where we used to be," he said, with the parties working together.

Such talk about cooperation with Republicans only fuels suspicion on the left, though, that she will abandon pursuit of policies such as the public option.

"I think her instincts are more moderate than they like to claim -- more centrist, more establishment," said Bob Borosage, co-director of the liberal group Campaign for America's Future. He said he is hopeful, though, "In her coalition, the energy is more on the left."

Write to Laura Meckler at laura.meckler@wsj.com

(END) Dow Jones Newswires

August 18, 2016 05:44 ET (09:44 GMT)

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