Axios

HCA, a publicly traded chain of 170 hospitals and 118 surgery centers, recorded only a mild boost to its profit from patients who bought health insurance through the Obamacare exchanges.

HCA's chief financial officer, Bill Rutherford, said on an earnings call Wednesday that even though HCA hospitals had seen more Obamacare patients in 2016, just 2.7% of all hospital admissions and 2.4% of emergency room visits were from exchange members. Obamacare had a net positive effect to HCA's adjusted earnings before interest, taxes, depreciation and amortization of roughly 5%.

For 2017, Rutherford said the $41.5 billion company expects to see a modest increase in Obamacare patients, but he admitted that's a "subjective" guess given the current climate to repeal and replace the law.

Why this matters: People with Obamacare coverage have gone to the hospital and doctor more, but those patients are just a small fraction of a hospital's business. Medicare and Medicaid, the two primary government health insurance programs, are much more vital to hospital chains like HCA. Obamacare's Medicaid expansion, in particular, has heavily reduced uncompensated care.

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.)

Aetna announced this morning that its fourth-quarter profit dropped 57%, to $139 million. Most of the drop in profit was tied to an early retirement program Aetna offered last fall as a way to slash costs. The Obamacare exchanges dragged down its overall profitability, but Aetna's government programs, specifically Medicare, continue to rake in taxpayer-funded cash. Aetna's total revenue in 2016 was $63.2 billion, a 4.7% jump from 2015.

Why it matters: Even though Aetna's net profit shrank in the fourth quarter, analysts thought it could've been worse for the health insurance giant.

The bigger issue is figuring out what to do now that its proposed acquisition of Humana was struck down. Aetna continues to say it is considering an appeal, but it gave 2017 guidance as if it were a "stand-alone" company.

Some interesting Obamacare figures: Aetna had to pay $690 million into the Affordable Care Act's risk adjustment program, which is used to help out insurers that had the most expensive customers in the marketplaces. The insurer also expects to receive $465 million under the risk corridor program, based on results from 2014 through 2016. Aetna bailed on most of the exchanges, not because they weren't profitable, but because Aetna was trying to get approval for its Humana deal.

The House Energy and Commerce Committee is probably going to take the continuous-coverage approach, which means people with pre-existing conditions will be covered as long as they have kept themselves insured. Here's the discussion draft of their bill, which the committee will talk about at a hearing Thursday. It has all of the language about requiring the coverage from insurers, but the continuous-coverage language hasn't been written yet.

Committee aides tell me that part is likely to be introduced by Rep. Susan Brooks, but the details — like how long a person would have to stay insured — are still being worked out. Their goal is to find the right incentives for people to stay insured, and to mirror employer-based coverage as closely as possible. Also still being discussed: whether to prevent insurers from charging more to people with pre-existing conditions, not just require insurers to cover them.

Other bills the committee will talk about on Thursday:

• Letting insurers vary premiums by age at a 5 to 1 margin, rather than 3 to 1 under Obamacare.
• Verifying that people who sign up outside of open enrollment are eligible to do it.
• Setting the grace periods for paying premiums to match state laws.

This week gives Republicans a chance to try to recover from last week's stumbles, which included a GOP retreat that didn't produce any clear consensus on an Obamacare replacement plan — but did produce a leaked recording of everyone arguing about it behind closed doors. There was also the Trump administration's attempt to shut down Obamacare outreach, partially dialed back on Friday so it's limited to $4 million to $5 million in TV and radio ads. (The official HealthCare.gov Twitter account is back to tweeting reminders to sign up.)

Couple of things to watch this week:

Will piecemeal work? It's clear that the House, at least, is starting with a bunch of smaller Obamacare replacement bills, with crucial details they're still working out. That's certainly the case with pre-existing conditions. Republicans are trying to shut down the talk that they don't have plans, but they don't have a ton of time to work out details if they want to meet their goal of a House vote by early March.

Will Obamacare enrollment recover? There won't be a total blackout of Obamacare outreach after all, but it's not clear how much that will help the signup effort. One way or another, open enrollment is ending under an administration that's hostile to the law. The message it sent by trying to stop outreach, according to Larry Levitt of the Kaiser Family Foundation, is that it "seems more intent on accelerating the demise of the health law than on running the program effectively and keeping insurance markets stable."

Most Republicans agree on one part of their Obamacare replacement: It will include greater use of health savings accounts. But after years of outcry over rising deductibles and out-of-pocket spending under Obamacare, they could face their own backlash over this policy — because it's built on, well, high deductibles and out-of-pocket spending.

President Trump himself endorsed health savings accounts at the Republican retreat in Philadelphia last week, saying they give people more choice over what insurance plan is right for them. But he's also been vocal about the need to lower deductibles and out of pocket spending, echoing the populist outcry over health care costs.

But health savings accounts are tied to high-deductible plans — and that's deliberate, because the idea is to make consumers take more responsibility for their health care spending. Greater use of the savings accounts "runs counter to Trump's talk about lower deductibles and out of pocket expenses," Ed Lorenzen, a senior adviser at the Committee for a Responsible Federal Budget, tells Axios.