Centene Corporation & US Health Insurance
Former EVP at Centene Corporation
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Interview Transcript
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Can you draw a direct line between the loss of institutional knowledge with Jesse and Brent and the current issues, like businesses being underpriced and parts of the business struggling? Do you think that's related or is it too far-fetched?
I don't think it's directly related. The government-sponsored insurance industry in the U.S. is under duress. The Big Beautiful Bill will take a significant amount of money out of Medicaid and disrupt the health insurance marketplace. These government programs are already under cost pressures. Not only Centene, but its competitive peer group, have all mentioned rising medical costs and uncertainty over the population size they can serve in the next two to four years. There's also general political uncertainty. About 60% of Centene's business is Medicaid, and the number of lives available to insure will decrease after these cuts go into effect post-midterm elections. This will affect their ability to maintain top-line earnings and manage costs, impacting their bottom line. This trend is similar across the competitive board. I don't think this is a short-term hit where the stock will bounce back quickly. It's a risky proposition given the current political and fiscal environment in the government-sponsored healthcare space.
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I also want to ask about how Centene wins new states and retains existing states for Medicaid contracts. I was reading about this, looking into various states, and it seems quite inconsistent. In some states, Centene is praised for its performance, while in others, they score low on quality metrics. I'm confused about how this process works and was hoping you could elaborate on it.
Essentially, long-term personal relationships with regulators and legislators play a crucial role. Brent Layton was instrumental in winning many state contracts. He started consulting with Centene around 2006 and was previously the insurance commissioner in Georgia. He was very politically savvy. We had strong board representation with Tommy Thompson, a former Republican governor, and Dick Gephardt, a former Democratic House member. During Michael's time, they were invaluable in navigating the political side of the procurement process. Brent, along with his team, built strong relationships. However, the current board lacks members with such deep political experience, which I see as a shortcoming. Dick and Tommy significantly contributed to Centene's growth and success during their tenure.
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I also want to ask about the ACA exchange business. Centene has seen significant growth in this area, especially in recent years, primarily through the Ambetter brand. Is it accurate to say that this growth is primarily due to pricing strategies, or are there other factors contributing to it?
The discipline on pricing came from the strategic decision to focus on the lower-income, highly subsidized portion of the exchange population, not on the zero-subsidy portion. That's what I believe led to Centene's success. I don't know what the Big Beautiful Bill will do to subsidies. I know there are cuts coming, which will negatively affect Centene's business in 2027 and beyond, but I haven't done any analysis on what that impact might be.
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