2027 Oscar Insurance Company Public Comments

Below are comments received regarding Oscar Insurance Company

Premiums do not dictate the cost of healthcare. They are a mathematical reflection of the underlying claims expenses.

If the Iowa Insurance Division continues to evaluate rate filings in a vacuum, focusing strictly on the payer rather than the supplier, the state will face an unsustainable cycle of premium spikes followed by catastrophic carrier market exits, leaving Iowans with zero choice.

To protect the integrity of Iowa's commercial insurance market, the IID must ground its evaluation of the 2027 rates in the undeniable supplier-side inflation and structural flaws outlined in its OWN recent Annual Health Care Costs Report:

The public routinely accuses health plans of discretionary corporate price-gouging, yet the state’s own actuarial data reveals the true drivers of premium growth. The IID’s report explicitly notes that Outpatient Hospital costs skyrocketed by 26%, Emergency Room costs increased by 18%, and Prescription Drug costs rose by 17%. These double-digit spikes are economically alarming when compared to the baseline Consumer Price Index (CPI) of 3.0% for the same period.

Hospital systems are inflating their outpatient and emergency billing at more than *eight times* the rate of standard economic inflation, forcing health plans to raise premiums simply to cover these mandated, pass-through liabilities.

In the Annual Report, the Insurance Commissioner explicitly admits: "our data has been limited to the insured market, which significantly limits our understanding of the drivers in the continued year-over-year increases in health care costs. This is a critical regulatory confession. By focusing oversight almost exclusively on insurance companies rather than the consolidated hospital systems dictating the prices, regulators are trying to fix the dashboard instead of the engine.

The IID cannot effectively regulate premium affordability without aggressively scrutinizing why Iowa's consolidated provider networks are insulated from standard market economics and value-based care models.

The double-digit rate increases proposed for 2027 are a predictable downstream consequence of the expiration of the ARPA and IRA enhanced subsidies. The state’s data correctly forecasted a massive price shock for middle-class Iowans earning over 400% of the Federal Poverty Level —such as a 55-year-old Iowa couple whose monthly contribution legally jumped from $599 to $1,666. This artificial "subsidy cliff" incentivizes healthy, self-sustaining consumers to drop out of the ACA market. This leaves carriers with an older, sicker, and highly volatile risk pool, structurally forcing the severe rate hikes currently requested for 2027.

If health plans are forced by political pressure to absorb a 26% increase in outpatient hospital claims without corresponding premium adjustments, the market becomes completely unviable.

Insurers have no mechanism to control these costs when cross-market hospital mergers eliminate regional competition.

Persistent member dissatisfaction and artificial rate suppression will inevitably trigger carrier market exits. Iowa is already experiencing the reality of this destabilization with major carrier pullbacks in the individual marketplace. If the IID does not curb provider pricing power, the individual and small group markets will collapse entirely, granting consolidated hospital conglomerates an absolute monopoly over healthcare delivery and eliminating consumer choice.

**Conclusion**

Capping or denying premium growth without addressing the unchecked pricing leverage of consolidated hospital systems is mathematically impossible. IID must utilize its regulatory frameworks to investigate anti-competitive hospital contracting, limit predatory outpatient facility fees, and transition Iowa's provider networks away from inflationary fee-for-service models.

True consumer protection requires regulating the suppliers who set the prices, not just the payers who write the checks.

--Received via webform from “Emily”

I live in Clear Lake, Iowa. I am currently insured through Oscar Insurance Company and rely on the ACA Marketplace to obtain health coverage.
 
I strongly oppose Oscar’s proposed premium increase for 2027. My out-of-pocket monthly premium has already risen from approximately $65 to $294 due to changes in Marketplace pricing and financial assistance. That is an increase of $229 per month, or $2,748 per year. 
 
Even if my payment increased only by Oscar’s proposed average of 11.94%, it would cost me approximately another $35 per month and more than $420 per year. These increases are not occurring in isolation. Iowans are already paying more for housing, food, transportation, utilities, and other necessities. Health insurance is supposed to protect our financial stability, but repeated premium increases are instead becoming a threat to it. Paying nearly $300 each month is already a substantial burden, especially when that premium does not include deductibles, copayments, prescriptions, or other out-of-pocket medical costs.
 
I am a working Iowan. I am not asking for free coverage; I am asking for coverage that remains realistically affordable. People should not have to choose between maintaining health insurance, building emergency savings, paying down debt, or meeting ordinary household expenses. Continuing to approve increases of this size will push more people toward plans with inadequate coverage or force them to become uninsured altogether.
 
I respectfully ask the Iowa Insurance Division to closely examine Oscar’s and other insurance companies justification for this increase, require clear evidence that it is necessary, and reject or substantially reduce any increase that cannot be fully justified. Please consider not only the insurer’s financial projections, but also the cumulative financial burden being placed on the Iowans who must pay these premiums.
 
Affordable health coverage cannot remain affordable if substantial increases are approved year after year. Please protect Iowa consumers from another increase that further erodes their financial security.