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Jacquelyn Martin/AP

The Aetna-Humana merger is all but dead after a judge said the deal would ruin competition, especially in Medicare Advantage.

But the ruling shed some damning light on how the Obamacare marketplaces factored into the deal, and how Aetna executives wanted to use their participation and withdrawals from the marketplaces to help gain approval for their deal.

Here are some of the most controversial Obamacare portions of the Aetna-Humana ruling.

  • Aetna CEO Mark Bertolini had been optimistic about Obamacare's insurance exchanges but decided to bail on most markets last year after suffering losses. The ruling showed he viewed Aetna's exits as a way to gain leverage in its litigation against the Department of Justice.
"Bertolini believed that DOJ should not block the merger in view of Aetna's role in advancing the ACA and participating in the exchanges, and Aetna was willing to offer to expand its participation in the exchanges if DOJ did not block the merger, or conversely, was willing to threaten to limit its participation in the exchanges if DOJ did."
  • Steven Kelmar, Bertolini's chief of staff, put the heat on Health and Human Services Secretary Sylvia Mathews Burwell before the Department of Justice intervened.
Kelmar told Secretary Burwell that if the merger was blocked, Aetna "would likely have to revisit its plans for and presence on the public exchanges."
  • In one email, Bertolini expressed anger at the Obama administration's decision to block the Humana deal even though he had publicly supported the exchanges.
"The administration has a very short memory, absolutely no loyalty and a very thin skin."
  • There was a concerted effort from Aetna executives to conduct conversations over the phone or in person to keep them out of court review. But some emails were found through the discovery process, including those from Christopher Ciano, the president of Aetna's Florida market. Ciano was perplexed Aetna was leaving his state's Obamacare exchange even though Aetna was making a profit.
"Really disappointed we are pulling the plug on Florida." Ciano followed up with "I just can't make sense out of the Florida decision...Never thought we would pull the plug all together. Based on the latest run rate data...we are making money from the on-exchange business. Was Florida's performance ever debated?" [Jonathan Mayhew, head of Aetna's exchange business] responded with a request to discuss via phone "instead of email." As Mayhew explained in court, these requests for phone calls were an attempt to avoid leaving a paper trail.

The full 158-page ruling from Judge John Bates can be viewed here.

Go deeper

2 hours ago - World

U.S. drone strike victims' families in Afghanistan seek compensation

A relative of Ezmarai Ahmadi, who was killed by a U.S. drone strike, looks at the wreckage of a vehicle that was damaged in the strike in the Kwaja Burga neighbourhood of Kabul on Saturday. Photo: Hoshang Hashimi AFP via Getty Images

Relatives of 10 Afghans killed by a U.S. drone strike in Kabul last month said Saturday they want to see punishment and compensation over the deaths.

Driving the news: The relatives said it's "good news" that the U.S. had "officially admitted" that "they had attacked innocents" in the Aug. 29 strike that killed Zamarai Ahmadi, an aid worker with a U.S.-based group, and nine family members, but they still need "justice," per AFP.

Miriam Kramer, author of Space
6 hours ago - Science

All-civilian Inspiration4 is back on Earth after flight to space

A side-by-side of the Inspiration4 crew and a shot of their capsule on the way back to Earth. Photo: SpaceX

The all-civilian Inspiration4 crew is back on Earth after their three-day mission in orbit.

The big picture: The launch and landing of this fully amateur, private space crew marks a changing of the guard from spaceflight being a largely government-led venture to being under the purview of private companies.

28 U.S. citizens depart Afghanistan on Qatar Airways flight

Passengers board a Qatar Airways aircraft bound to Qatar at the airport in Kabul on September 10, 2021. Photo: Aamir Qureshi/AFP via Getty Images

The State Department on Saturday confirmed that a Qatar Airways charter flight left Kabul on Friday with 28 U.S. citizens and seven lawful permanent residents on board.

The big picture: Friday's flight is the third such airlift by Qatar Airways since the Taliban takeover of Afghanistan, AP reports.