Aetna ACA exit is bad for marketplace, good for Oscar: CEO Bertolini

Fri, May 9, 2025, 6:15 AM 2 min read

Oscar Health (OSCR) CEO Mark Bertolini has helped pb the security tech institution into a play of accordant profitability aft years of losses.

The seasoned wellness security enforcement has go an manufacture advocator for change, calling the existing employer-sponsored security marketplace broken. He told Yahoo Finance successful an interrogation Thursday that healthcare is the lone spot successful the system wherever individuals deficiency prime implicit decisions.

"I cognize what my concerns are for my health, I cognize what I need, wherefore americium I having to spell done the security institution to get it approved?" Bertolini said.

It's wherefore Oscar has worked connected accessing wellness services done its technology-enabled platforms. The institution boasts a long-time narration with OpenAI (OPAI.PVT), which has helped it make plans and products that are "frictionless," Bertolini said.

"Those frictionless attraction models let maine to get what I need, connected my terms, astatine my cost," helium said. "Everywhere other successful our economy, we tin get that."

But not successful healthcare, wherever security plans are designed by employers for maximum options to cater to the divers needs of the worker colonisation — which raises the wide outgo of insurance.

Bertolini, formerly the CEO of Aetna (CVS), said this is wherefore the constrictive networks and little outgo options successful the Affordable Care Act marketplace are amended for individuals. And wherefore Aetna's exit isn't bully for the market.

"The much players successful the market, the better, successful ample portion due to the fact that everyone has constrictive networks ... [which] let you to get a little terms point, due to the fact that you're moving gross to less players," Bertolini said.

That besides helps support insurers profitable, arsenic it balances the fig of high-cost and low-cost patients successful the premix astatine immoderate fixed time.

"Our presumption is we don't request to get each the members," Bertolini said. "We privation the members that request our products and our networks. We privation to service them good astatine a terms constituent that, for the past 3 years, has been astatine oregon beneath the outgo of inflation."

Still, Aetna's exit bodes good for Oscar, which had "significant overlap" with them, Bertolini said connected an net telephone Wednesday.

"We presumption that arsenic an accidental to assistance radical support their sum astatine a level of pricing that we find disciplined and competitory successful the marketplace," helium said.

Anjalee Khemlani is the elder wellness newsman astatine Yahoo Finance, covering each things pharma, insurance, attraction services, integer health, PBMs, and wellness argumentation and politics. That includes GLP-1s, of course. Follow Anjalee arsenic AnjKhem connected societal media platforms X, LinkedIn, and Bluesky @AnjKhem.