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.
SACRAMENTO, Calif. — Covered California announced that 263,320 people had newly selected a health plan for 2023, continuing a trend of steady growth in recent years. The total is more than 14,000 higher than 2021’s total, and 8,000 higher than last year’s figure. In addition, more than 1.4 million Californians renewed their health insurance for 2023, bringing Covered California’s overall enrollment to 1.74 million.
“Covered California is woven into the fabric of our health care system, providing quality coverage in every corner of the state and protecting more than 1.7 million Californians,” said Jessica Altman, executive director of Covered California. “The strength in these numbers is driven by the Inflation Reduction Act, which provides increased and expanded financial help, bringing the cost of coverage within reach for millions of Californians who need health insurance.”
Covered California Provides New Opportunities for People to Sign Up for Health Insurance Through Special Enrollment
SACRAMENTO, Calif. — Covered California is reminding Californians that they still have an opportunity to sign up for quality health insurance and get financial help to lower the cost of their monthly premiums even though open enrollment ended on Jan. 31. Every year, Covered California allows people who have experienced a significant life event to sign up for coverage during special enrollment.
“Californians can still protect themselves and their families with quality health insurance for the rest of the year, if they have had a major change in their lives,” said Jessica Altman, executive director of Covered California. “If you have recently lost your coverage, gotten married, had a baby, or have been affected by California’s winter storms, visit CoveredCA.com to check out what plans are available to you.”
With time running out, Covered California announced new enrollment data and encouraged consumers to sign up for coverage before this year’s open-enrollment period ends.
As of Jan. 29, more than 240,000 consumers had newly signed up for health insurance through Covered California during the current open-enrollment period. In addition, more than 1.5 million Californians have renewed their coverage for another year.
That's a grand total of at least 1,740,000 people...or around 21,000 higher than CMS had reported California being at as of January 15th. Note the "more than" clarifier re. the 1.5M figure; this suggests that the actual total could be as much as ~40K or so higher.
First-of-its-kind initiative will help people get the behavioral health care they need as they leave incarceration
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved a first-of-its-kind section 1115 demonstration amendment in California which will provide a set of critical pre-release services and improve access to critically needed care for people returning home from jails and prisons.
For example, Medi-Cal will be able to cover substance-use treatment before a Medicaid beneficiary is released from jail, prison, or youth correctional facility. Additionally, the state will be able to help connect the person to community-based Medicaid providers 90 days prior to their release to ensure they can continue their treatment after they return to the community.
