On June 1, Aetna and UW Medicine failed to agree on a new insurance contract. More than 50,000 Aetna members learned that every UW hospital, clinic and doctor was now out-of-network, forcing them to choose between paying sky-high bills or abandoning physicians they’ve trusted for years.
Who’s at fault? Each side blames the other, and the talks are closed to public view. The only certainty is the loser: patients. I know this firsthand. I trained at UW in internal medicine, still send my sickest hospital patients there for transplants and advanced cancer care, and carry Aetna insurance through my employer. When the deal collapsed, patients suffered, and clinicians scrambled. If this sounds bad, imagine how it feels for my patient who is only halfway through a chemotherapy regimen at UW.
Aetna, part of CVS Health, shoulders most of the blame. CVS cleared $4.6 billion in profit last year, and its stock is up more than 50% in 2025. CEO David Joyner made over $17 million in 2024. Incoming Aetna CEO Steve Nelson said the quiet part out loud at a 2019 UnitedHealth town hall: Insurers lobby “a lot more than you would think” against reforms like Medicare for All — but try not to draw attention, because “the last thing you want to do is become the poster child.”
Aetna has used this playbook before, letting contracts lapse with Providence in Oregon and clashing with California’s Sutter Health. A corporation that rewards its leaders and shareholders so richly can afford to keep UW Medicine in-network.
UW Medicine, a public nonprofit, faces real headwinds: looming Medicaid cuts and uncertain federal research funding. But UW has obligations, too. Federal rules require hospitals to publish detailed price lists so the public can see what each insurer pays. UW’s data still lacks the specificity needed to verify its claims about Aetna’s rates.
UW’s past approach to negotiations with its own resident physician union also raises concerns about how consistently it bargains in good faith. If UW wants public trust, it should publish clear, detailed financial reports so patients, voters, and lawmakers can judge how well public dollars are being spent.
What can we do now? If your employer offers Aetna, speak up. Tell HR and company leaders you expect a plan that keeps UW in-network, or that you want a different carrier if no deal is reached. If you buy your own policy, or have an Aetna Medicare Advantage plan, prepare to switch during open enrollment on Oct. 15, and let Aetna know why you switched.
Second, contact your lawmakers. Support Washington House Bill 1589, which requires insurers to bargain in good faith and expands state oversight. But urge lawmakers to strengthen it by replacing its $5,000 fine with a penalty big enough to matter.
Finally, demand transparency. Ask Aetna and UW for regular public updates — not just finger-pointing, but real information about what’s holding up the deal.
More broadly, we must fix the system that enables this. Employer-sponsored insurance, which is how half of Americans still get coverage, ties health security to employment. Lose your job and you lose care. Stay in a job you’ve outgrown, and you’re captive to whatever network your company chooses. Many people remain in jobs they would otherwise leave just to keep seeing their doctors, distorting the labor market and suppressing wages.
The U.S. is nearly alone among wealthy nations in clinging to this model. A single-payer system would follow us from job to job, cut administrative waste and direct dollars to care rather than shareholder dividends. Insurance companies fear that future. Patients shouldn’t.
Until we build something better, contract breakdowns like this will keep deciding who gets treated — and who gets shut out.
