Why some payer execs are betting big on individual markets

Some payer CEOs are feeling optimistic about the future of marketplace insurance. 

Speaking at the Bank of America Securities Global Healthcare Conference on Sept. 13, Centene CEO Sarah London said she believes the individual marketplace will eventually be the dominant way that consumers shop for health insurance. 

With the extension of government-sponsored subsidies, Centene saw huge growth in marketplace coverage over the last enrollment cycle, Ms. London said. 

"Smaller businesses that don't or can't afford to scalably provide insurance for their employees are encouraging them to move over and purchase individually on the exchanges," she said. "Many of them are actually eligible for subsidies, so it's more affordable for both parties to consume in that way." 

The Inflation Reduction Act extended subsidies for marketplace coverage through 2025. Though there is a risk these subsidies will not be renewed, Ms. London said, political leaders on both sides of the aisle have indicated the marketplace is here to stay. 

"What's interesting is the extension of the subsidies stabilized the marketplace, not just because of the existence of subsidies themselves, but because it was seen by many as a signal that the repeal and replace, the debate going on between Republicans and Democrats to try to pull back the Affordable Care Act, has died. Essentially, everybody believes the marketplace is here to stay," she said. 

On-exchange enrollment reached a record high in 2023 of 15.7 million in 2023, driven by subsidies, according to KFF. 

Mark Bertolini, CEO of Oscar Health, was also bullish on the future of the marketplace. 

In 2010, some in the industry feared Congress would defund Medicare Advantage,but the program reached 15 to 20 million lives — too big to undo, Mr. Bertolini said at the Morgan Stanley Global Healthcare conference Sept. 11. 

"I would argue we're at the same place with the ACA today. We're going to be at 18-some million [enrolled] by the time January rolls around. I think it's going to be too hard for them to blow it up," he said. 

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