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AP file photo

Here are the main takeaways from Aetna's fourth-quarter report and investor call:

Still immensely profitable: Don't let Aetna's Obamacare losses obscure the fact that this is still a massive health insurance company that is making a lot of money from the taxpayer-funded Medicare and Medicaid programs, as well as from people who have employer coverage. Aetna covers more than 23 million people.

An appeal decision on Humana is coming soon: Aetna is still weighing its options after the proposed merger was struck down. Mark Bertolini, Aetna's chief executive, said the insurer would decide whether to appeal the judge's ruling before Feb. 15, the deal's expiration date. If Aetna throws in the towel, it will have to pay Humana a $1 billion termination fee.

Aetna won't re-enter the Obamacare markets: Bertolini told investors "the intended goals of the (Affordable Care Act) have not been achieved," and that Aetna has no intention of re-entering or expanding into the marketplaces next year since the risk pools will deteriorate. But he said he was optimistic the next health care reform debate will focus on the "lack of access to affordable health care." That word — "access" — mirrors the language of House Speaker Paul Ryan and is very different from universal coverage.

Doing fine on Medicare Advantage: Aetna is highly profitable in the private alternative to traditional Medicare, proving it can do just fine without Humana, a Medicare Advantage powerhouse. Bertolini and crew also subtly mentioned that it has a "strong pipeline" for its Medicare Advantage plans offered through employers and other large groups. (Last year, the company argued that cuts to employer Medicare Advantage rates would harm seniors and the program. Nothing of the sort has happened.)

Go deeper

Dan Primack, author of Pro Rata
3 hours ago - Politics & Policy

Democrats' billionaires tax explained

Illustration: Aïda Amer/Axios

There is now legislative language behind the push to tax American billionaires on unrealized capital gains, as Sen. Ron Wyden last night released his 107-page plan.

Why it matters: This would be a sea change in U.S. tax policy, which has only applied to realized gains (otherwise known as income).

4 hours ago - World

Scoop: Blinken protests Israel settlements approval in "tense" phone call

Benny Gantz (L) and Tony Blinken. Photo: Jacquelyn Martin/Pool/AFP via Getty

Secretary of State Tony Blinken protested the decision to approve 3,000 new housing units in Israeli settlements in the occupied West Bank during a tense phone call on Tuesday with Israeli Defense Minister Benny Gantz, three Israeli officials tell me.

Why it matters: This is the first time new construction in the settlements has been approved since President Biden assumed office, and the Biden administration had been privately pressing the Israeli government not to proceed.

The startup that wants to disrupt big internet providers

Illustration: Maura Losch/Axios

A new startup backed by funding from AOL founder Steve Case and Laurene Powell Jobs wants to break up broadband monopolies across the country.

Why it matters: Internet access has been crucial during the pandemic, but it's not ubiquitous, and it can be both slow and unaffordable in swaths of the country.

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