81. How Mighty Big Healthcare Has Fallen
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81. How Mighty Big Healthcare Has Fallen
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About this listen
About The Podcast:
Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.
Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.
Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.
Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.
Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.
Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.
About The Episode:
On this episode, Marc discusses how the mighty big healthcare companies have fallen, in this case a victim of their own financial mismanagement and shenanigans.
Key Takeaways:
A number of external forces contributed to problems in the health insurance industry.
Margins have collapsed. McKinsey finds that the EBITDA Compound Annual Growth Rate for insurers was -1.2% from 2019 to 2024.
Big Healthcare has been vertically integrating a great deal over the past two decades. This has usually powered their growth and investors flocked to their sticks.
But a number of large health plans have suffered major financial problems and some of the problems are impacting their non-insurance entities as well.
Big Healthcare has tended to have it better financially than other insurers, but that has changed recently.
Big healthcare has relied too much on suspect practices, such as risk adjustment maximization, robust prior authorization, marketing deals with brokers, and intercompany arrangements derived from vertical integration.
While regional players have been hit by a financial downturn too, their greater focus on member care and relationships have put them in better shape right now.
Big healthcare had bigger hits on underwriting margin and medical loss ratio (MLR) in 2024 in Medicare Advantage (MA). Regional players also did better than Big Healthcare on MA enrollment for 2025.
Connect with Marc
Marc on LinkedIn Marc on Twitter THL Podcast Resources THL’s Newsfeed THL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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