One of the largest not-for-profit health insurers is committed to offering plans in the Affordable Care Act marketplaces even as some of its peers jump ship.
Kaiser Permanente, the $61 billion system that includes health plans, hospitals and medical groups, is “absolutely” sticking with the exchanges over the long term, Kaiser CEO Bernard Tyson told Modern Healthcare last week.
“I view it through the lens of my mission,” he said. “It obligates us to figure it out, not to get out.”
Kaiser covered about 860,000 people in the individual market as of July, a majority of whom have bought their health plans through the online exchanges. Most of Kaiser's ACA enrollees live in California. Across the country, there are about 11.1 million people with exchange coverage, and an estimated 9 million people have purchased individual plans off the exchanges without subsidies.
Tyson conceded the market is “unstable” right now. The ACA exchange population has been much sicker and more costly than initially expected, which economists, executives and policymakers agree has led to some adverse selection. Congress also has restricted risk-corridor funding that was supposed to buffer losses in the early years.
That has certainly contributed to the industry's financial problems with the exchanges, Tyson said. But he argued there's a simple reason some plans have made a profit while others lost hundreds of millions of dollars.
“There were conscious decisions made in the pricing of the product when it first started that did not hold logic to the marketplace,” Tyson said.
That is, some plans deliberately underpriced their products to gain market share assuming “over time it's going to work itself out,” he said. “This is not rocket science.”