Oscar Health Insurance Corp. may be a top contender for the most hip insurance startup out there — it certainly has eye-catching subway ads — but its ability to turn a profit in a highly competitive industry is another matter. The company lost $105.2 million in 2015 on plans offered in New York and New Jersey through exchanges created under the Affordable Care Act.
The losses are a sign of both the particular struggles Oscar faces as a newcomer in a health insurance market dominated by enormous and well-established companies as well as the challenges insurers face more generally in a healthcare landscape that has undergone seismic changes with the passage of the Affordable Care Act, nicknamed Obamacare, in 2010.
The company disclosed Oscar lost $92.4 million in New York State and $12.8 million in New Jersey in state regulatory filings, Bloomberg reported. The company got its start in New York in 2013 and has since garnered nearly $330 million in investment from groups like Google Capital and Goldman Sachs, boasting subway ads that appeal to a younger crowd as well as innovations like financial rewards for members who meet certain fitness goals.
The company began offering plans outside New York and New Jersey for 2016, expanding to parts of Texas and two counties in California. In California, however, it struggled to gain traction, attracting some 2,000 marketplace enrollees, or 0.1 percent of the 1.57 million who bought health insurance through the state exchange for the year, and 3,000 nonmarketplace subscribers. About 145,000 people have signed up for Oscar’s insurance across all of its markets for 2016.
Oscar CEO Mario Schlosser has said the market remains viable, Bloomberg reported. The company has narrowed its network of doctors and hospitals, and Schlosser said, as Oscar enrollment increases, it has been able to negotiate prices with providers. Still, in 2015, Oscar took in $127.3 million in net premiums, but in New York, it spent more that that medical costs.
Other, more established insurers like UnitedHealth Group Inc. and Aetna have grappled with similar challenges on plans sold through Obamacare exchanges. In November, UnitedHealth, the largest health insurer in the U.S., said it was considering leaving those marketplaces in 2017 because of struggles to turn a profit on these plans because of low enrollment. It has projected it will lose $650 million from these plans in 2015 and 2016.
Aetna said its policies sold on Obamacare exchanges posted losses of 3-4 percent in 2015. “We continue to have serious concerns about the sustainability of the public exchanges,” Mark Bertolini, Aetna’s CEO, said in February.