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Oscar Health, Inc.
Health Care · Managed Health Care
Structural: pure-play on the ACA Individual market, the fastest-growing US insurance segment (24M+ enrollees in 2024 vs ~12M in 2021) thanks to enhanced premium subsidies under the IRA. Oscar runs on a single in-house tech stack (claims, member portal, care routing) vs legacy carrier mainframes, which it argues compounds into a structural MLR / SG&A advantage as it scales.
- Hit first full-year GAAP profit in 2024 (~$25M net income) after a decade of losses - inflection name, not a story stock anymore
- ACA subsidies extended through 2025; if Congress renews, total addressable enrollment keeps growing
- Bertolini chairmanship (ran $AET) signals operator credibility + likely strategic optionality (sale, partnership, or platform pivot)
- +Oscar tech-platform licensing to legacy carriers ($CI Cigna+Oscar partnership) is high-margin optionality not in core multiples
- Sub-scale vs $UNH / $ELV - every 100bps of MLR improvement is meaningful operating leverage
- Single-product concentration: ACA marketplace is ~95% of revenue, leaving Oscar fully exposed to subsidy non-renewal post-2025
- Medical Loss Ratio remains volatile (80s%) and a 200bps miss wipes a year of operating income
- Larger MCOs ($ELV, $CNC, $CVS Aetna) compete on the same exchanges with deeper provider networks
- Risk-adjustment payments to CMS are lumpy and have repeatedly surprised the model
- Still small-cap (~$4B), insider supply from co-founders + Thrive Capital overhang
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