HMSA earnings fall while Kaiser posts loss

Uncertainty surrounding Obamacare dragged down the financial results last quarter of the state’s two largest health insurers.

Hawaii Medical Service Association reported a $6.3 million second-quarter profit that was about half of what it earned a year ago.

Kaiser Permanente Hawaii, the state’s largest health maintenance organization, lost $11.9 million in the quarter after posting a $3.7 million profit in the year-earlier period.

“With the uncertainty around the federal health law, we’re more focused than ever on local health solutions like payment transformation, and (wellness programs) Sharecare and the Blue Zones Project that improve the health of Hawaii,” HMSA Chief Executive Officer Michael Gold said Tuesday in a news release.

HMSA is seeking ways to mitigate the effect of Obamacare after reporting losses of $48 million in 2015 and 2016 for Affordable Care Act individual plans and expecting another loss this year.

Kaiser, meanwhile, said it collected $45.5 million in premiums and spent $65.1 million on Obamacare claims in 2016.

Both companies are seeking to boost Obamacare health insurance rates next year — HMSA by an average 27.1 percent and Kaiser by 19.9 percent. Together that would affect nearly 33,000 residents. The health plans filed the proposed rate hikes with the federal government two weeks ago.

In the second quarter, HMSA collected $854.8 million in premiums — up from $780.5 million in the year-earlier period — and spent $774.4 million, compared with $686.2 million, on doctor visits, hospitalizations, prescription drugs and other medical expenses for its 732,116 members.

HMSA said the cost of administering those benefits (including taxes and fees related to ACA) totaled $74.8 million, down from $82 million. That left the state’s largest health insurer with an operating gain of $5.6 million, down from $12.3 million. Gains from investments added $4.2 million to the health plan’s bottom line, compared with $5.1 million in the year-ago period when its quarterly profit totaled $12.3 million.

The insurer’s reserve, which protects members from financial loss due to unexpected situations such as disease outbreaks and natural disasters, grew to $469.6 million, or $641 per member per month, compared with $358.2 million, or $488 per member.

Kaiser, which assumed control of three Maui County hospitals in July, did not give a reason for the loss, but said it “remained focused on keeping expenses down” with medical expenses rising at about 3 percent in 2016 compared with the average national cost of 4 to 5 percent.

The HMO — both a medical provider and health plan — collected $365.7 million in revenue in the quarter that ended June 30, compared with $340.5 million a year ago. It spent $378.6 million on medical benefits, up from $337.9 million. That resulted in an operating loss of $12.9 million, compared with a gain of $2.6 million in the year-earlier quarter. The health plan with 251,010 members gained $1 million in income from investments, down from $1.1 million. Kaiser said its membership grew by 3,533 from the same time last year.