A letter, unearthed by The Huffington Post, surfaced from Bertolini to the DOJ's Ryan Kantor that stated, “unfortunately, a challenge by the DOJ to that acquisition and/or the DOJ successfully blocking the transaction would have a negative financial impact on Aetna and would impair Aetna's ability to continue its support, leaving Aetna with no choice but to take actions to steward its financial health. These contemplated actions would include the actions discussed below.

“Although we remain supportive of the Administration’s efforts to expand coverage, we must also face market realities. Our customers expect us to keep their insurance products affordable and continually improving, and our shareholders expect that we will generate a market return on invested capital for them. We have been operating on the public exchanges since the beginning of 2014 at a substantial loss. And although we have been working to improve our operations over the last 2 1⁄2 years, we are challenged to get to break even this year, and it will be some time before we recoup our investment (including a return on invested capital in the exchange business). As we add new territories, given the additional startup costs of each new territory, we will incur additional losses. Our ability to withstand these losses is dependent on our achieving anticipated synergies in the Humana acquisition.”


The blatant nature of this quid-pro-quo was not lost on Sen. Elizabeth Warren, who blasted the Aetna decision on her Facebook page:

“In July, the Justice Department announced that it would sue to block Aetna’s merger with another health insurance company because it would create monopoly-like conditions that reduce competition and drive up insurance costs,” she stated. “Aetna says this change of tone about the Affordable Care Act has nothing to do with the merger – but some analysts have suggested that Aetna might 'use its future participation in the exchanges in bargaining over its purchase of Humana.'

“Aetna may not like the Justice Department’s decision to challenge its merger, and it has every right to fight that decision in court. But violating antitrust law is a legal question, not a political one. 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.”

The Anthem-Cigna deal would slash competition in a total of 121 metropolitan areas in 14 states, according to the AMA findings. Nine of the 14 are pushing to prevent the merger as an antitrust violation.

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