In this week's Pulse Extra, Crain's New York Business examines the financial performance of New York insurers as reported in annual filings to the National Association of Insurance Commissioners. They compare the health plans' net income or loss last year to 2015. Net income is total revenue minus total expenses. The insurers earn money from premiums and investment income, and spend money on hospital and medical benefits, prescription drugs, taxes and administrative costs.
The fortunes of New York City insurers were mixed last year with plans backed by the largest U.S. insurers reaping big profits while Affordable Care Act-focused startups continue to lose money. Oxford, a UnitedHealthcare subsidiary reported about $364 million in net income, the largest of any local plan whose financial statements are available. It was followed by EmblemHealth's GHI, at $260.3 million. But much of that profit is the result of the $330 million sale of its Ninth Avenue office building.
Empire HealthChoice Assurance, which issues EPO and PPO coverage, earned $193 million, a 33% increase in profit from 2015. Meanwhile venture capital–backed startup Oscar lost $124.1 million in New York, and CareConnect lost $156.2 million, which it said was the result of a broken federal risk adjustment program that resulted in the company paying out 45% of the premiums it earned in its small-group business to its competitors.
EmblemHealth's HIP lost $239.2 million during Chief Executive Karen Ignagni's first full year at the company. Ignagni has vowed to turn Emblem around by shifting more of its contracts to value-based payments and upgrading the insurer's technology in an effort to better manage members' costs.
Financial filings from other plans, such as Aetna, were not yet available online, while the financial statements of Medicaid plans, which are regulated by the state Department of Health, are not available through the National Association of Insurance Commissioners.