Oscar, Centene bet on Obamacare as other insurers pull back on exchanges
Eyeing potential growth opportunities, Centene Corp. and startup Oscar Health plan to expand their footprints on the ACA marketplaces.
While Republican leaders in the Senate were crafting their plan to replace the Affordable Care Act, the nation’s insurers were calculating how much risk they are willing to take in the individual market. In the end, some insurers made their escapes. Others indicated they would stay for 2018. And a couple are swooping in to pick up the business that’s left behind.
Insurers had until last Wednesday— one day before the draft Senate bill was released—to announce whether they would sell plans on the ACA exchanges in 2018. Insurers could still pull out by fall, but the initial deadline provides a first look at the shape of the individual market. Several, including Aetna and Humana, previously said they would stop offering individual plans in certain markets, citing financial losses and uncertainty over whether key provisions of the healthcare law would remain in play.
Anthem, which covers 1.1 million exchange members and had wavered over whether to sell exchange plans next year, pulled out of marketplaces in Indiana and Wisconsin, following a previous announcement to drop out of Ohio. But the insurer filed preliminary rates in 11 other states. MDWise, an Indianapolis-based insurer, also will leave Indiana’s marketplace, saying it lost $21 million on exchange plans in 2016. Its exit will affect 30,800 members. Eyeing opportunities for growth, Centene Corp. and New Yorkbased startup Oscar Health plan to expand their footprints on the ACA marketplaces. Centene, which has experience managing the care of low-in- come Medicaid members, will start offering coverage on exchanges in Kansas, Missouri and Nevada, while expanding its presence in the six states where it currently sells plans. Centene covers 1.2 million exchange members.
Despite losing millions on the exchanges in 2016 and 2015, Oscar Health filed to expand into certain counties in Ohio, New Jersey and Tennessee. The startup, founded by Joshua Kushner, previously sold plans in New Jersey but exited the market this year. Oscar will also expand its presence in California and Texas and will keep selling plans in New York. In 2017, Oscar covered about 105,000 members.
Others, including Molina Healthcare and Highmark Health, indicated that they will continue to sell coverage in each of the states where they currently operate. Chicago-based Health Care Service Corp. also filed rates in the five states where it sells exchange coverage, but a spokeswoman for the insurer said no final decisions have been made regarding participation or products.