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Which Insurer Is Best Positioned for the ACA?

Jeremy Glaser
Vishnu Lekraj

Jeremy Glaser: For Morningstar, I'm Jeremy Glaser. What impact will the glitches in the Affordable Care Act's exchanges have on the managed-care organizations? I'm here with Vishnu Lekraj, a Morningstar senior analyst, to look at this question.

Vishnu, thanks for joining me today.

Vishnu Lekraj: Thanks, Jeremy.

Glaser: Let's talk a little bit about what kind of glitches people are encountering right now. When you try to sign up for one of these exchanges, what's happening? Are people enrolling the way that insurers had initially expected?

Lekraj: Apparently, there is a big bottleneck in the whole public insurance exchange market that's run by the federal government. Within the public exchange market, you have two types: the state-run and the federal-run. A lot of the state-run public exchanges have run very smoothly; the rollout has been very good. If you look at California, for example, it's a very smooth rollout. But the states that chose not to run their own exchange, the ones that chose to have the federal government run the exchange, those are where you're finding a lot of the problems. And it looks like the government was underprepared and underinvested and didn't do a lot exactly to roll it out in a smooth manner.

Glaser: What's the open-enrollment period look like? How long does the government have to fix this before it becomes a bigger problem?

Lekraj: Theoretically they have as long as they want. I think they pushed back the open-enrollment date to March now in terms of there being the individual mandate coming into play for fines, taxes, and whatnot.

They can push around the dates. They want to delay the employer mandate a year. But the crux of the Affordable Care Act is the individual mandate, and it's going to be hard for them to push that back any further than what it has been.

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Glaser: If they can't get the exchanges up and running or they're not running smoothly, what happens if the mandate did have to get pushed back? Is that going to weigh heavily potentially on the private insurers?

Lekraj: I'll put it this way. It'll be disastrous for the ACA and disastrous for the administration. The key piece of legislation the Obama administration passed since President Obama came into office was the ACA, and the key part of that is the individual mandate. In order for the insurance markets to work, in order for everything to connect together in terms of all legislation pieces of the ACA, the individual mandate needs to be in there. And that's why there's such see a key focus on that aspect of the ACA.

Glaser: Why is the mandate so important? Why can't this operate without it?

Lekraj: Because you need everyone participating within the insurance market. If you don't, then you're going to get a situation where you're just going to end up with a lot of sicker patients at the end of the day. Insurance companies will probably leave the market in that case, pricing will become extreme, and you'll see premiums start to go up versus them either holding flat or falling as the administration claims they should.

Glaser: Let's take a look at the investing lens of this then. For these private insurers, what does this mean if they have this uncertainty hanging over them? Have they been pulling back from the marketplaces? How are they approaching this situation?

Lekraj: You see different strategies being executed by different insurers, and the managed-care organizations, the ones Morningstar analysts cover, the major five--Humana, Aetna, Cigna, UnitedHealth, and WellPoint--all five of those players have taken different tactics as far as how they're going to handle the exchanges.

You see a few going to the private exchanges. You see some getting involved with the public exchanges. WellPoint is the one that's been the most involved, and it's going to be the most affected moving forward in terms of the public exchanges and how that rolls out here in the beginning stages and how it ultimately plays out over the longer term.

Glaser: When thinking about the long-term then, let's say that some of these initial problems get worked out and the individual mandate isn't delayed. Who is best-positioned to take advantage of all these new potential customers?

Lekraj: The problems will get ironed out, so they will be taken care of. That's for sure. Again, that's going to be the key piece of this legislation. With that said, WellPoint, I think, is positioned the best out of all the MCO's we cover in terms of being involved with the public exchanges and taking advantage of them over the longer term.

However, I would put a caveat on that. It depends upon pricing. It depends upon premiums moving forward past two to three years. Everything is going to depend upon how everything is going to play out, not necessarily this year or next year, but the years beyond.

But for the near term, as long as everything gets ironed out here over the next couple of quarters, WellPoint is the best positioned. It's been the most aggressive, and it has probably the best brand out there out of all the insurers. It has the Blue Cross, Blue Shield brand in about 14 states in the country. That's the most recognizable brand within the health insurance industry as far as the consumer's perspective.

Glaser: How about from a valuation standpoint? Is WellPoint attractively priced right now?

Lekraj: Again, WellPoint is the best priced right now in my opinion. It's undervalued significantly from where I have my fair value estimate. In my opinion, it's going to take advantage of not only the public exchanges--there's been some internal turmoil within that firm over the past couple of years which sent the stock price down slightly--but with the new management team in here, with the new strategic plan, they should get those internal headwinds corrected and increase profitability and ultimately increase the stock price.

Glaser: It sounds like there might be some short-term bumps, but over the long term you still think that the law is a net positive for these private insurers?

Lekraj: Definitely. And WellPoint has a narrow moat, so we believe it has some good competitive advantages to it. And again, it should help in the long term.

Glaser: Vishnu, thanks so much for your thoughts today.

Lekraj: Thank you.

Glaser: For Morningstar, I'm Jeremy Glaser.