Oscar Health will exit the California individual ACA insurance market for plan year 2024 as part of a push to make its insurance business profitable.
On a May 9 call with investors, transcribed by Seeking Alpha, Oscar Health CEO Mark Bertolini said the company is exiting underperforming markets to improve its profitability.
"The company has been disciplined in managing its portfolio and improving the sustainability of our margins over time," Mr. Bertolini said.
Oscar Health plans to reenter the California market in the future, Mr. Bertolini said.
Interim CFO Sid Sankaran said the California market represents less than 5 percent of Oscar Health's membership, with around 35,000 members in the state.
This suggests that Oscar has roughly 700,000 ACA exchange enrollees nationally, FWIW.
Attorney General Bonta Announces $2.1 Million Settlement Against Companies Over Sham Health Insurance Plans
OAKLAND — California Attorney General Rob Bonta today announced a $2.1 million settlement against two companies, Shared Health Alliance, Inc. (SHA) and Alliance for Shared Health (ASH), to resolve allegations that they offered and deceptively advertised sham health insurance and violated insurance regulations that protect consumers. ASH, a nonprofit corporation that purported to be a healthcare sharing ministry (HCSM), created, operated, and sold unauthorized health insurance through its for-profit administrative vendor, SHA.
A new bill introduced in the California state Senate aims to lay the groundwork for a state universal healthcare system, proposing an incremental approach that departs from recent sweeping, and unsuccessful, efforts to reshape how Californians receive care.
Under the measure by state Sen. Scott Wiener (D-San Francisco), California would begin the process of seeking a waiver from the federal government to allow Medicaid and Medicare funds to be used for a first-in-the-nation single-payer healthcare system.
“In the wake of COVID-19’s devastation, and as costs for working people have skyrocketed, the need to provide affordable healthcare to all Californians has never been greater,” Wiener said in a statement. He touted his measure as making “tangible steps on a concrete timeline toward achieving universal and more affordable healthcare in California.”
WASHINGTON, DC — President Joe Biden invited Covered California’s Executive Director Jessica Altman and other health leaders from across the country to the White House to celebrate the 13th anniversary of the enactment of the Affordable Care Act. The landmark law, which has helped provide quality health care coverage for more than 40 million Americans, represents the most significant improvement to our nation’s health care system since the passage of Medicaid and Medicare more than five decades ago.
“All Americans deserve the peace of mind that if an illness strikes or an accident occurs you can get the care you need,” President Biden said. “The Affordable Care Act has been law for 13 years; it has developed deep roots in this country and become a critical part of providing health care and saving lives.”
(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.
Again, this doesn't just mean that they can't get federal financial help; it means they can't enroll via ACA exchanges at all:
Undocumented immigrants aren’t eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans. But they may apply for coverage on behalf of documented individuals.
Sometimes the simplest bills can have huge positive impacts. California Assembly Bill 503 was introduced by Democratic Assemblymember Juan Carrillo in February.
AB 503, as introduced, Juan Carrillo. Health care: organ donation enrollment. Existing law, the Uniform Anatomical Gift Act, authorizes the creation of a not-for-profit entity to be designated as the California Organ and Tissue Donor Registrar and requires that entity to establish and maintain the Donate Life California Organ and Tissue Donor Registry for persons who have identified themselves as organ and tissue donors upon their death. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department, in consultation with the board governing the California Health Benefit Exchange, to develop a single paper, electronic, and telephone application for insurance affordability programs, including Medi-Cal.
The COVID-19 pandemic continues to surge across the nation, endangering Americans and filling our hospitals from coast to coast. In the middle of this rising crisis, nearly 80 percent of the health insurance marketplaces, including all of those supported by the federally facilitated exchange (FFE) and a small number of state-based exchanges, are set to close their open-enrollment periods on December 15th.
We are writing to recommend that the Centers for Medicare and Medicaid Services (CMS) extend the Healthcare.gov open-enrollment period through January 31st or, at a minimum through December 30th, to allow Americans more time to sign up for health care coverage during this pandemic.
As COVID-19 Pandemic Surges Across the State, Covered California Takes the Unprecedented Step of Giving Consumers Until Dec. 30 to Sign up Up for Coverage that That Begins on Jan. 1
Physicians and health centers across the state announce they are reaching out personally to all their patients to encourage them to stay safe from COVID and get insurance coverage if they are eligible — many will receive Covered California’s masks to get the message out that now is the time to get covered and stay covered.
California’s leading provider organizations — including the California Hospital Association, California Medical Association, California Academy of Family Physicians, the California Primary Care Association and America’s Medical Groups — are making sure the trusted voice of physicians and other health care heroes are speaking to millions of Californians with the message of remaining vigilant until the vaccine arrives.
According to a survey conducted by Covered California, the pandemic continues to touch most Californians, finding that 52 percent of Californians say the pandemic has affected their lives significantly, more than 40 percent personally know someone who has tested positive for the virus, and more than one in four people knows someone who has died from COVID-19.
The timing of this press release is a little odd; it came out on November 9th, even though the 2021 ACA Open Enrollment Period actually launched on November 1st. In fact, in California specifically, they've been allowing existing enrollees to actively renew/re-enroll for 2021 since October 1st!
Given the insanity of this year's Presidential election on November 3rd, along with the ongoing COVID19 pandemic, I can hardly blame CoveredCA for the delay, however; after all, this is the first Open Enrollment update I've posted since it kicked off on Nov. 1st as well...
Covered California Officially Launches Open Enrollment with Millions of Masks to Encourage Californians to “Get Covered/Stay Covered” and a New Ad Campaign
