Oscar Health CEO: Why the company is a 'healthcare piñata' in an election year
Oscar Health (OSCR) posted its second quarterly profit ever in the company's history last week — and upgraded its 2024 outlook.
Still, the New York healthcare insurer is bracing for renewed attacks on the Affordable Care Act (ACA) market if former President Donald Trump returns to the White House.
The company reported total revenue of $2.2 billion, an increase of 46% year over year, and net income of $56 million, or $0.20 per share, compared to a loss of $15 million, or $0.07 per share, in the second quarter of last year.
Membership is also increasing: 63% year over year to 1.6 million. But that's because the company is benefitting from the government changes to Medicaid after the pandemic ended , which resulted in a significant number of individuals losing coverage.
KFF estimates more than 20 million individuals have been dropped from Medicaid as a result, pushing them into becoming uninsured or relying on the ACA marketplace.
It's why CEO Mark Bertolini told Yahoo Finance the company is the "healthcare piñata" and acts as a bellwether for the political climate and sentiment towards the ACA, also known as Obamacare.
Oscar's stock fell after the first Biden-Trump debate on CNN on June 27, as Biden's performance suggested a sweep for the Republicans, which would likely mean another push to overthrow the ACA, a long-standing GOP goal.
The company's stock dropped from $17.80 per share at market open to $15.82 on June 28, the day after the debate.
Bertolini fielded calls asking him to make a statement on social media to quell fears "We had all these people, including Josh Kushner, saying, 'Mark, you've gotta say something on Twitter.' And I said, 'No, it's not going to matter. No one is going to listen to me talking about subsidies on Twitter,'" Bertolini said.
Josh Kushner, an Oscar Health co-founder, is the brother of Jared Kushner, former President Donald Trump's son-in-law. Jared Kushner also has a stake in Oscar.
Republicans have made many attempts to do away with the ACA over the years.
The most recent example: During the Trump administration, a penalty was removed for those individuals who don't get health insurance in violation of the individual coverage mandate. Federal subsidies that made it easier for lower-income individuals to access health insurance were also reduced.
Beyond 'repeal and replace'
But there may be some hope in the long-term outlook for Oscar.
"We are seeing a notable shift in sentiment from federal and state policymakers. They are moving beyond 'repeal and replace' to creating constructive solutions that position the marketplaces to better serve more Americans," Bertolini said on a second quarter earnings call last week.
The focus has shifted to, for example, cutting fraud and further reducing subsidies.
Bertolini noted that in the years since the ACA market was established, it has become more stable — which is something insurers crave and could boost participation.
"The ACA ... has created the largest risk pool in the industry, resulting in a significantly lower cost trend than conventional employer-sponsored coverage," Bertolini said.
"Our big issue, at my level, is how do we push through the political dynamic. Hopefully, we come out the other side bruised but not [broken]," he told Yahoo Finance.
Still, Bertolini said Oscar is no longer putting all eggs in one basket. The company is now looking at other areas of growth, with a particular focus on smaller businesses using the individual coverage Health Reimbursement Arrangement (HRA) . Employers can reimburse employees for the cost of their insurance plan and out-of-pocket costs through this program, which has been gaining popularity in recent years.
Bertolini said he hopes to make Oscar the brand of choice for ICHRA as more states enact laws to make it easier to offer this option.
Meanwhile, the company is expected to report its first profitable year in its 12-year history. (That's after burning through more than $1 million per day for years, Bertolini said.)
"We think the year's going to be a very good year for the company. We're on the edge of being EBITDA profitable for the whole year," Bertolini said.
Anjalee Khemlani is the senior health reporter at Yahoo Finance, covering all things pharma, insurance, care services, digital health, PBMs, and health policy and politics. Follow Anjalee on all social media platforms @AnjKhem .
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