Aetna will drop out of health insurance exchanges if they are not profitable enough

[zipplewrath]

20. But it's not an empty threat

You suggested that their statements were "BS". I don't think they are kidding when it comes to small markets, especially where they don't have an existing presence. If the margins get too small, they'll leave it to competitors to fill in. (I'd guess around 7-13% margin) Now, in large markets, they may be afraid to not join in and figure it out as the go along, but I'd suspect they are already in those markets and know the costs well.

You can say "let them" but those small markets may have trouble getting companies to populate their exchanges. It was one of the reasons that the left rejected the whole "just let companies sell across state lines" schtick the GOP was selling. There are small markets in which there may only be 1 or 2 significant sources. It isn't clear that other companies would move into those markets, with our without national insurance reforms.