Centene Corp (CNC) 2025 Q2 法說會逐字稿

Good morning, and welcome to the Centene Corporation's second-quarter earnings conference call. (Operator Instructions) Please note, today's event is being recorded.

早安，歡迎參加 Centene Corporation 第二季財報電話會議。（操作員指示）請注意，今天的活動正在被記錄。

I would now like to turn the conference over to Jennifer Gilligan, Senior Vice President, Finance and Investor Relations. Please go ahead, ma'am.

現在，我想將會議交給財務和投資者關係高級副總裁 Jennifer Gilligan。請繼續，女士。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our second-quarter 2025 earnings results conference call. Sarah London, Chief Executive Officer; and Drew Asher, Executive Vice President and Chief Financial Officer of Centene will host this morning's call, which also can be accessed through our website at centene.com.

謝謝你，羅科，大家早安。感謝您參加我們的 2025 年第二季收益結果電話會議。Centene 執行長 Sarah London 和執行副總裁兼財務長 Drew Asher 將主持今天早上的電話會議，您也可以透過我們的網站 centene.com 存取。

Any remarks that Centene may make about future expectations, plans, and prospects constitute forward-looking statements for the purpose of the safe harbor provision under the Private Securities litigation Reform Act of 1995. Specifically, our discussion today about expectations for the drivers of adjusted EPS for 2025 and any commentary unexpected adjusted EPS for 2025 are forward-looking statements.

Centene 對未來預期、計畫和前景所作的任何評論均構成 1995 年《私人證券訴訟改革法案》安全港條款規定的前瞻性陳述。具體來說，我們今天討論的 2025 年調整後每股收益驅動因素的預期以及任何對 2025 年意外調整後每股收益的評論都是前瞻性陳述。

Actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in our second quarter of 2025 press release sent, Centene's most recent Form 10-Q filed this morning and 10-K filed on February 18, 2025, and other public SEC filings which are available on the company's website under the Investors section.

由於各種重要因素，實際結果可能與這些前瞻性陳述所示的結果存在重大差異，包括我們發送的 2025 年第二季度新聞稿中討論的因素、Centene 今早提交的最新 10-Q 表和 2025 年 2 月 18 日提交的 10-K 表，以及可在公司網站“投資者”部分下找到的其他公開 SEC 文件。

Centene anticipates that subsequent events and developments may cause its estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our second quarter 2025 press release.

Centene 預計後續事件和發展可能會導致其估計發生變化。雖然公司可能選擇在未來某個時間點更新這些前瞻性聲明，但我們明確表示不承擔任何這樣做的義務。此次電話會議也將參考某些非公認會計準則指標。在我們 2025 年第二季的新聞稿中可以找到這些指標與最直接可比較的 GAAP 指標的對帳。

We are unable to reconcile our commentary on adjusted -- expected adjusted EPS for 2025 to the corresponding GAAP measures due to the difficulty of predicting the timing and amounts of various items within a reasonable range. Finally, following the call, the team's prepared remarks will be posted on the Investors Section of our website.

由於難以在合理範圍內預測各種項目的時間和金額，我們無法將對調整後——預期 2025 年調整後每股收益的評論與相應的 GAAP 指標相協調。最後，電話會議結束後，團隊準備好的演講稿將發佈在我們網站的投資人部分。

With that, I would like to turn the call over to our CEO, Sarah London. Sarah?

說完這些，我想把電話轉給我們的執行長莎拉倫敦 (Sarah London)。莎拉？

Thanks, Jen, and thanks everyone for joining us. We have a lot to cover this morning, so let me start by outlining a few key elements of my prepared remarks. First, I'll provide more detail on the marketplace risk adjustment challenge we previewed earlier this month, including what happened and what actions we're taking to mitigate the financial impact with an eye to restoring the book to profitability in 2026.

謝謝，Jen，也謝謝大家加入我們。今天早上我們要討論的內容很多，因此，請允許我先概述我準備好的發言稿中的幾個關鍵內容。首先，我將更詳細地介紹我們本月早些時候預覽的市場風險調整挑戰，包括發生了什麼以及我們為減輕財務影響而採取的措施，以期在 2026 年恢復盈利能力。

Second, I will address the elevated medical cost trend that drove our higher Q2 Medicaid HBR result. How we are addressing it and an updated view on the positive progression of Medicaid rates. Third, I'll review our updated outlook for 2025. And finally, I'll share our perspective on how the policy landscape in the wake of the One Big Beautiful Bill Act, or OB3, and how that informs our view of 2026 and beyond.

其次，我將討論導致我們第二季醫療補助 HBR 結果上升的醫療成本上升趨勢。我們如何解決這個問題以及對醫療補助率積極進展的最新看法。第三，我將回顧我們對 2025 年的最新展望。最後，我將分享我們對《一項偉大的美麗法案》（OB3）之後的政策前景的看法，以及這對我們對 2026 年及以後的看法有何影響。

Before we jump in, let's level set with what we printed this morning. We reported second quarter results for 2025 inclusive of an adjusted per share loss of $0.16. We are disappointed by this performance and frustrated to have fallen short of the financial goals we set at the start of the year.

在我們開始之前，讓我們先來回顧一下今天早上印刷的內容。我們公佈了2025年第二季業績，其中調整後每股虧損0.16美元。我們對此業績感到失望，也對未能實現年初設定的財務目標感到沮喪。

Our primary focus is restoration of our earnings trajectory, and the entire team is unified behind that goal, operating with a sense of urgency and discipline as we work to improve performance across the portfolio and drive results that will generate tangible shareholder returns. As you will hear, we are aggressively taking actions to put our marketplace business on a path to recovery and enhanced profitability for 2026.

我們的主要重點是恢復獲利軌跡，整個團隊團結一致，朝著這一目標努力，以緊迫感和紀律性開展工作，努力提高整個投資組合的業績，推動產生切實的股東回報。正如您所聽到的，我們正在積極採取行動，使我們的市場業務走上復甦之路，並在 2026 年提高盈利能力。

In Medicaid, we have clear line of sight into what is driving our trend, and we are active pulling the levers necessary to correct our trajectory. And finally, our Medicare Advantage business is achieving significant operational progress, paving our path to break even in 2027 and profitability in the years to follow.

在醫療補助方面，我們清楚地了解了推動我們趨勢的因素，我們正在積極採取必要的措施來糾正我們的軌跡。最後，我們的醫療保險優勢業務正在取得重大營運進展，為我們在 2027 年實現收支平衡和未來幾年盈利鋪平了道路。

With that, let's dig in, beginning with Marketplace. We reported second quarter marketplace membership of 5.9 million members as the book continued to grow, driving more than $10 billion of commercial premium and service revenue in the period. Revenue in the quarter was negatively impacted by the previously disclosed shortfall in projected 2025 risk adjustment transfer revenue generating a drag of approximately $1.2 billion in pre-tax for the segment.

有了這些，我們就從市場開始深入研究吧。我們報告稱，隨著圖書銷售的持續增長，第二季度市場會員人數已達 590 萬，推動了該期間超過 100 億美元的商業保費和服務收入。本季的收入受到先前披露的預計 2025 年風險調整轉移收入缺口的負面影響，導致該部門稅前收入減少約 12 億美元。

In addition to the risk adjustment challenge, the underlying performance of our marketplace business was impacted by higher levels of utilization. We've incorporated this elevated utilization into our full year 2025 outlook, which we will address in a few moments.

除了風險調整挑戰之外，我們的市場業務的基本表現還受到更高利用率的影響。我們已將這項利用率提升納入 2025 年全年展望中，稍後我們將對此進行討論。

Now let's talk about the risk adjustment challenge in a bit more detail. On July 1, we announced that with information on approximately 72% of our membership, we were tracking to earnings pressure of $1.8 billion in 2025 as a result of a change in marketplace risk adjustment transfer assumptions. This was based on data from Wakely, an independent actuarial firm that aggregates market growth and morbidity information on behalf of carriers on the individual marketplace.

現在讓我們更詳細地討論風險調整挑戰。7 月 1 日，我們宣布，根據約 72% 會員的數據，由於市場風險調整轉移假設的變化，我們預計 2025 年的獲利壓力將達到 18 億美元。這是基於獨立精算公司 Wakely 的數據得出的，該公司代表個人市場上的承運商匯總市場增長和發病率資訊。

Since this announcement we have received our additional files and spent meaningful time reviewing the findings. Based on the complete data set, we now expect full year 2025 marketplace earnings to be pressured by $2.4 billion, which represents 100% of the membership impact. Analysis of the full data confirmed a significant shift in the marketplace risk pool in 2025, which we now believe is primarily being driven by three things.

自從這篇公告發布以來，我們收到了額外的文件，並花了大量時間審查調查結果。根據完整的數據集，我們現在預計 2025 年全年市場收益將受到 24 億美元的影響，佔會員影響的 100%。對完整數據的分析證實，2025 年市場風險池將發生重大轉變，我們現在認為這主要是由三件事推動的。

First, a higher-than-expected percentage of healthy and or low utilizing members left the marketplace during open enrollment, which was likely the result of program integrity measures that were introduced after 2024 pricing was finalized and implemented for the 2025 open enrollment cycle.

首先，在開放註冊期間，健康或低利用率會員離開市場的比例高於預期，這可能是在 2024 年定價最終確定並為 2025 年開放註冊週期實施後引入的計劃完整性措施的結果。

Second, new sign-ups to the market had higher morbidity likely reflecting changes in the underlying member mix for redeterminations and the same program integrity guardrails deterring new healthy sign-ups in 2025. And third, a step up in marketplace utilization more broadly combined with more aggressive provider coding is likely driving higher in-year documented morbidity.

其次，新進入市場的會員發病率較高，這可能反映了重新確定的底層會員結構的變化，以及相同的計劃完整性護欄阻礙了 2025 年新健康會員的註冊。第三，更廣泛的市場利用率與更積極的提供者編碼相結合，可能會導致年度內記錄的發病率更高。

Together these dynamics have shifted the morbidity of the market in some states as much as 16% to 17% year-over-year. Ultimately, Ambetter was underpriced for this morbidity shift. As a result, we now expect the product to run slightly below breakeven for the remainder of 2025 instead of within our target margin range of 5% to 7.5%. This is obviously a disappointing outcome, but we are not taking it standing still.

這些動態因素共同導致一些州的市場發病率較去年同期上升了 16% 至 17%。最終，Ambetter 的定價因發病率的轉變而被低估。因此，我們現在預計該產品在 2025 年剩餘時間內的獲利水準將略低於損益平衡點，而不是在我們 5% 至 7.5% 的目標利潤率範圍內。這顯然是一個令人失望的結果，但我們不會坐視不管。

We immediately turned our focus to mitigating the impact of this pricing miss with the goal of returning the business to profitability in 2026. As of this morning, we have already filed 2026 pricing in 17 states. We expect to submit adjusted pricing files in up to 12 additional states within the next week and anticipate state certification of rates over the next month. Based on what we know today, we continue to believe that we will be able to reprice the 2026 portfolio to account for a substantial majority of marketplace membership, and our goal is to reprice 100% of the book.

我們立即將重點轉向減輕此定價失誤的影響，目標是在 2026 年恢復業務獲利。截至今天上午，我們已經在 17 個州提交了 2026 年的定價。我們預計將在下週內向最多 12 個其他州提交調整後的定價文件，並預計下個月將獲得各州的費率認證。根據我們今天所了解的情況，我們仍然相信，我們將能夠重新定價 2026 年的投資組合，以涵蓋絕大多數市場會員，我們的目標是重新定價 100% 的帳簿。

Importantly, our 2026 pricing adjustments account for the morbidity shifts we observed in the 2025 data, but they also account for shifts we now expect to see in certain markets in 2026, informed by the scale of our data and our unique ability to see correlations across the 29-state footprint. As a reminder, initial 2026 pricing was already set to current law of the land, which means we have accounted for the potential expiration of eAPTCs.

重要的是，我們對 2026 年價格的調整不僅考慮了我們在 2025 年數據中觀察到的發病率變化，還考慮了我們現在預計在 2026 年某些市場中會出現的變化，這些變化是根據我們的數據規模以及我們獨特的在 29 個州的範圍內觀察相關性的能力得出的。提醒一下，2026 年的初始定價已經根據現行法律確定，這意味著我們已經考慮到 eAPTC 的潛在到期。

In addition to addressing pricing, we are actively looking at ways to leverage our position in the market to create more transparency around market dynamics earlier in the year. We are also engaged with the administration as they prepare to implement the next wave of program integrity measures to ensure the mechanics for open enrollment 2026, both achieved their goals and ensure that eligible members can readily access high-quality, affordable health insurance on the federal exchange.

除了解決定價問題外，我們還在積極尋找方法來利用我們在市場中的地位，以便在今年稍早提高市場動態的透明度。我們也與政府合作，準備實施下一波專案完整性措施，以確保 2026 年開放註冊的機制既實現其目標，也確保符合資格的成員能夠在聯邦交易所輕鬆獲得高品質、負擔得起的健康保險。

While the individual marketplace will be absorbing the impact of regulatory changes for at least one more cycle, it does not change the fact that millions of Americans rely on this critical infrastructure to access health care coverage. We remain committed to supporting our almost 6 million members in getting the care they need to keep themselves and their families healthy and as we do so, we are focused on returning our marketplace portfolio to profitability in the short term and sustainable profitable growth over the long term.

雖然個人市場將至少再承受一個週期的監管變化的影響，但這並不能改變數百萬美國人依賴這個關鍵基礎設施來獲得醫療保險的事實。我們將繼續致力於支持我們近 600 萬會員獲得他們所需的護理，以保持他們自己和家人的健康，同時，我們專注於讓我們的市場組合在短期內恢復盈利能力，並在長期內實現可持續的盈利增長。

Turning to Medicaid. Our Medicaid portfolio also fell short of expectations in the second quarter, producing an unanticipated and unacceptable health benefits ratio of 94.9%. Driving this underperformance was a step up in medical cost trend in three areas: behavioral health, home health, and high-cost drugs.

轉向醫療補助。我們的醫療補助組合在第二季也未達到預期，產生了未預料到且不可接受的 94.9% 的健康福利比率。導致這種表現不佳的原因是三個領域的醫療成本趨勢上升：行為健康、家庭健康和高成本藥物。

Behavioral health was the most significant driver of the quarter-over-quarter increase with ABA or applied behavioral analysis as an accelerating pressure point across a number of our markets. In response, we have formed enterprise-wide behavioral health and ABA task forces to further support our markets in aggressively managing this trend.

行為健康是季度環比成長的最重要驅動力，而 ABA 或應用行為分析則是我們多個市場中加速成長的壓力點。作為回應，我們成立了企業範圍的行為健康和 ABA 工作小組，以進一步支持我們的市場積極應對這一趨勢。

Together they are focused on aligning members to high quality providers, a state partners around evidence-based clinical guidelines advocating for behavioral health-specific rate adjustments and rooting out fraud, waste, and abuse in service of better member outcomes. Within the underlying ABA trend, the largest concentration of pressure was isolated to a single program in a single state.

他們共同致力於將會員與高品質的醫療服務提供者聯繫起來，由國家合作夥伴圍繞循證臨床指南倡導針對行為健康的特定費率調整，並根除欺詐、浪費和濫用，以服務於更好的會員結果。在潛在的 ABA 趨勢中，最大的壓力集中在單一州的單一項目。

As a reminder earlier this year we inherited the ABA population in Florida within the Children's Medical Services contract for which we are the sole source provider. That population transitioned with inadequate rates and with a continuity of care provision limiting the use of managed care strategies to effectively manage services and associated costs.

提醒一下，今年早些時候，我們繼承了佛羅裡達州兒童醫療服務合約中的 ABA 人口，我們是該合約的唯一來源提供者。此族群的轉變是由於費用不足和照護服務的連續性限制了使用管理式醫療策略來有效管理服務和相關成本。

This provision lifted as of June 1, and we are already seeing the impact of clinical and administrative interventions. At the same time, we are also advocating with our state partner to address the underlying rate gap, both retroactively and prospectively.

該規定自 6 月 1 日起取消，我們已經看到臨床和行政幹預的影響。同時，我們也與國家合作夥伴一起倡導解決潛在的利率差距問題，包括追溯和前瞻性的措施。

Home health was the next largest contributor to trend across markets in Q2 with home and community-based services, or HCBS related to complex populations as the top driver. Here too, we are leveraging across enterprise approach to select high quality and high integrity providers in this space and ensure states have sufficient data to inform both rate and policy decisions.

家庭保健是第二季度各市場趨勢的第二大貢獻者，其中家庭和社區服務或與複雜人群相關的 HCBS 是主要驅動力。在這裡，我們也利用跨企業方法來選擇該領域的高品質和高誠信供應商，並確保各州有足夠的數據來為費率和政策決策提供資訊。

We saw HCBS pressure manifest in an outsized way in New York in Q2 due to rate insufficiency and state-driven program changes. As we saw this emerge, we deployed additional leadership resources to the New York market and are executing against a very clear roadmap to correct the overall trajectory, which is showing good progress as we move into Q3.

由於利率不足和國家推動的計劃變化，我們看到紐約第二季的 HCBS 壓力異常巨大。當我們看到這種情況出現時，我們向紐約市場部署了額外的領導資源，並按照非常明確的路線圖執行以糾正整體軌跡，隨著我們進入第三季度，這顯示出良好的進展。

High-cost drugs were the final driver of the Q2 step up with cancer drugs and gene therapy among the major categories contributing pressure. In addition to working with our partners to ensure clinical appropriateness for these treatments, we have also been ramping up efforts to educate our states on a sustainable cost containment, including through corridors or (inaudible)

高成本藥物是第二季成長的最終驅動力，其中抗癌藥物和基因治療是造成壓力的主要類別。除了與我們的合作夥伴合作以確保這些治療的臨床適用性之外，我們還一直在加強教育各州如何可持續地控製成本，包括透過走廊或（聽不清楚）

This is another place where the benefit of a 30-state Medicaid footprint means we can readily source best practices to inform solutions, and we are seeing states moving more quickly to make policy and program changes to better regulate this cost driver. In addition to pulling these more direct levers, we are hyper focused on securing rates that reflect current trends in order to deliver meaningful margin improvement for the Medicaid business.

這是 30 個州的醫療補助覆蓋範圍帶來的好處的另一個方面，這意味著我們可以隨時找到最佳實踐來提供解決方案，並且我們看到各州正在更快地制定政策和計劃變更，以更好地規範這一成本驅動因素。除了採取這些更直接的手段之外，我們還高度重視確保反映當前趨勢的利率，以便為醫療補助業務帶來有意義的利潤率提升。

As a reminder, 88% of our Medicaid franchise gets re-rated between 7/1/25 and 1/1/26 Over the last 18 months we have demonstrated the ability to secure outsized rate increases and engage constructively with our state partners to infuse more real-time data into the process. We are activating that same playbook in light of this recent step up in trend to push for faster rate correction.

提醒一下，我們 88% 的醫療補助特許經營權在 2025 年 7 月 1 日至 2026 年 1 月 1 日期間進行了重新評級。在過去的 18 個月中，我們已證明有能力確保超額費率成長，並與我們的州合作夥伴進行建設性合作，以將更多的即時數據注入到這一過程中。鑑於近期趨勢的上升，我們正在啟動同樣的策略，以推動更快的利率調整。

Our 7/1 and 9/1 rates have materialized better than our previous expectation, and we now expect a 2025 composite rate adjustment of 5% compared to 2024. This is stronger than the previous expectation of 4%-plus. We have important rate updates upcoming in our 10/1 states, including Florida, and we are already feeding current trend data to those states who will update rates 1/1/26 for 40% of our membership.

我們的 7/1 和 9/1 利率表現優於我們先前的預期，我們現在預計 2025 年綜合利率調整幅度將比 2024 年高出 5%。這比之前預期的4%以上強。我們即將在包括佛羅裡達州在內的 10/1 州發布重要的費率更新，並且我們已經在向那些將於 1/1/26 更新 40% 會員費率的州提供當前趨勢數據。

Despite the current dislocation, we remain confident in our ability to secure rates that are sufficient to address the current acuity and health care demand within the Medicaid population and support sustainable margins over the long term.

儘管目前存在混亂，但我們仍然有信心，我們有能力確保足夠的費率來滿足醫療補助人群當前的敏銳度和醫療保健需求，並支持長期可持續的利潤。

Turning to Medicare. PDP membership ended the quarter at 7.8 million members, roughly flat on a sequential basis. Our performance in this product exceeded our expectation in the period, allowing us to improve our outlook for full year results in PDP.

轉向醫療保險。本季末，人民民主黨會員總數為 780 萬，與上一季基本持平。該產品的業績超出了我們的預期，這讓我們能夠改善對 PDP 全年業績的展望。

The PDP program absorbed a number of regulatory changes in 2025, and with half the year behind us, we are now more comfortable with the assumptions we made around the impact of some of these changes. While our outlook for the product remains prudent, PDP is providing some earnings upside relative to our previous outlook.

PDP 計畫在 2025 年吸收了許多監管變化，如今已過去半年，我們對圍繞這些變化的影響所做的假設更加滿意。雖然我們對該產品的前景仍然保持謹慎，但相對於我們先前的展望，PDP 仍提供了一些獲利上漲空間。

Meanwhile, Medicare Advantage is making important progress on its path to margin recovery, thanks to effective 2025 pricing, an optimized footprint and continued operating discipline. To date, the book is running slightly favorable to expectations, and we continue to closely monitor components of costs such as outpatient surgery and pharmacy to ensure that we appropriately manage any evolving pressure.

同時，由於有效的 2025 年定價、優化的覆蓋範圍和持續的營運紀律，Medicare Advantage 在利潤率恢復的道路上取得了重要進展。到目前為止，該帳簿的運作情況略好於預期，我們將繼續密切監測門診手術和藥房等成本組成部分，以確保我們適當地管理任何不斷變化的壓力。

Relative to STARS, we are pleased with our continued performance improvements across multiple categories and particularly with gains we have seen in our clinical measures for members with chronic illnesses. We are still waiting for CAPS results and final cut points from CMS, but based on the data we have today, we still anticipate year-over-year progress in STARS. But challenging cut points may make our 85% target difficult to hit. As a reminder, we anticipated cut point headwinds coming into 2025 and have built a path to our 2027 breakeven target that does not rely on further STARS improvement.

相對於 STARS，我們對我們在多個類別中的持續表現改進感到滿意，特別是我們對患有慢性疾病的會員的臨床測量所看到的進步。我們仍在等待 CMS 的 CAPS 結果和最終分數線，但根據我們今天掌握的數據，我們仍然預期 STARS 將取得逐年進展。但挑戰臨界點可能會使我們的 85% 目標難以實現。提醒一下，我們預計 2025 年將出現臨界點逆風，並已製定了一條實現 2027 年盈虧平衡目標的路徑，不依賴 STARS 的進一步改善。

Based on our performance in 2025 to date, as well as the advancements we have made and expect to continue to make relative to clinical interventions, SG&A and value-based care alignment, we feel good about our path to break even in 2027 for Medicare Advantage and are pleased with the consistent progress we are making turning around this business.

根據我們在 2025 年迄今為止的表現，以及我們在臨床幹預、銷售、一般及行政費用以及基於價值的護理協調方面已經取得併預計繼續取得的進步，我們對 Medicare Advantage 在 2027 年實現收支平衡的道路充滿信心，並對我們在扭轉這一業務方面取得的持續進展感到高興。

As we think about the road ahead, our current forecast calls for full year adjusted diluted EPS of approximately $1.75. The following six items can help you bridge from our previous full year 2025 adjusted EPS guidance of $7.25, representing $4.55 billion of pretax to the $1.75. One as I mentioned earlier, we now estimate that the Marketplace morbidity shifts relative to our previous 2025 forecasts will create a $2.4 billion full year headwind to the 2025 pretax earnings.

展望未來，我們目前的預測是，全年調整後攤薄每股收益約為1.75美元。以下六點可以幫助您將我們先前預測的2025年全年調整後每股收益7.25美元（稅前收益45.5億美元）調整至1.75美元。正如我之前提到的，我們現在估計，相對於我們先前預測的2025年市場發病率變化，將對2025年稅前收益造成24億美元的全年不利影響。

Two, also in Marketplace, we have built in an additional $200 million in pretax margin pressure from expected back-half utilization, including the impact of members seeking care in advance of the expiration of eAPTCs. Three, in Medicaid, we reflected the rate increases we know for 7/1 and 9/1 but have been balanced about our assumptions for the 10/1 cohort.

第二，同樣在市場中，我們因預期的後半年利用率而產生了額外的 2 億美元稅前利潤壓力，其中包括會員在 eAPTC 到期前尋求護理的影響。第三，在醫療補助方面，我們反映了已知的 7/1 和 9/1 費率成長，但對 10/1 群體的假設進行了平衡。

Four, we have also assumed that we will continue to have trend pressure in the back half of the year such that the Medicaid HBR in the second half is approximately 93.5%. The overall change in full year Medicaid HBR represents an approximate $2.1 billion headwind on pretax earnings compared to our prior forecast.

第四，我們也假設下半年我們將繼續面臨趨勢壓力，因此下半年的醫療補助 HBR 約為 93.5%。與我們先前的預測相比，全年醫療補助 HBR 的整體變化對稅前收益造成了約 21 億美元的不利影響。

Five, we expect the Medicare segment to deliver approximately $700 million in pretax favorability in our -- compared to our prior forecast, largely driven by PDP but supported by better Medicare Advantage results as well. Embedded in this $700 million is the expectation of continued specialty trend in PDP and slight outpatient pressure in MA.

第五，我們預計醫療保險部門將帶來約 7 億美元的稅前優惠——與我們先前的預測相比，這主要受到 PDP 的推動，但也受到更好的醫療保險優勢結果的支持。這 7 億美元蘊含著對 PDP 持續專業化趨勢和 MA 輕微門診壓力的預期。

And finally, through continued aggressive SG&A management and natural leverage on growth, we expect to deliver an approximate net $500 million in pretax earnings in the buildup to $1.75 compared to our prior forecast.

最後，透過持續積極的銷售、一般及行政管理以及自然的成長槓桿，我們預計，與先前的預測相比，每股收益將達到 1.75 美元，稅前淨收益約為 5 億美元。

As we think about variation to that forecast, we believe the largest swing factor that could pressure the $1.75 would be a further acceleration of Medicaid trend in the back half of the year. To frame the downside for you, if we made no progress on HBR in the back half of the year compared to the first half, that could push the $1.75 as low as $1.25.

當我們考慮該預測的變化時，我們認為可能對 1.75 美元造成壓力的最大波動因素將是今年下半年醫療補助趨勢的進一步加速。為了向您說明不利的一面，如果我們在下半年與上半年相比在 HBR 上沒有取得任何進展，那麼 1.75 美元可能會跌至 1.25 美元。

With respect to upside to $1.75, we have tangible momentum in Medicaid on rate updates and policy changes, progress on clinical interventions and network design and increasingly effective initiatives to stamp out fraud, waste and abuse. The impact of that work could lead us to a better result than 93.5% in the back half of the year. And as a reminder, every 10 basis points of back half HBR improvement is $45 million in pretax.

關於上漲至 1.75 美元，我們在醫療補助費率更新和政策變化方面擁有切實的動力，在臨床幹預和網絡設計方面取得進展，並在消除欺詐、浪費和濫用方面採取了越來越有效的舉措。這項工作的影響可能會使我們在今年下半年取得比 93.5% 更好的成績。需要提醒的是，後半年 HBR 每提高 10 個基點，稅前收入就會增加 4,500 萬美元。

In Marketplace, we will get updated market morbidity data at the end of September and December, which could indicate we don't need the full $2.4 billion change in the Marketplace forecast. As the next few months progress, we will also have a better view on whether the additional $200 million provision for Marketplace trends was necessary. And finally, we will continue to pursue strategic SG&A opportunities as we look to rightsize the business for 2026. All of these factors could drive results higher than $1.75.

在市場中，我們將在 9 月底和 12 月底獲得更新的市場發病率數據，這可能表明我們不需要市場預測中全部 24 億美元的變化。隨著接下來幾個月的進展，我們也將更了解是否有必要為市場趨勢額外提供 2 億美元資金。最後，我們將繼續尋求策略性的銷售、一般和行政費用 (SG&A) 機會，以期在 2026 年實現業務規模調整。所有這些因素都可能導致業績高於 1.75 美元。

There are a number of very near-term milestones that will better inform our view of the full year outlook, including July and August results, 10/1 rate updates and the next tranche of Wakely data, all of which are expected by the end of September. We look forward to providing updates on our outlook as we gain additional visibility into these key inputs.

有許多近期里程碑將更能幫助我們了解全年前景，包括 7 月和 8 月的業績、10/1 利率更新和下一批 Wakely 數據，所有這些預計都將在 9 月底公佈。隨著我們對這些關鍵輸入有了更多的了解，我們期待提供關於我們展望的更新。

With that, let me take a moment to talk about 2026. We fully expect to deliver margin improvement in our three core lines of business in 2026 relative to the current 2025 forecast. Let's dig into that in more detail. We believe we are on track to reprice our Marketplace business for meaningful margin improvement in 2026.

說到這裡，我想花點時間談談 2026 年。我們完全有信心，2026 年我們三大核心業務線的利潤率將相對於目前的 2025 年預測有所提高。讓我們更詳細地探討一下。我們相信，我們預計在 2026 年重新定價我們的市場業務，以實現利潤率的大幅提高。

While the last month has been incredibly challenging for this business, the team has far more clarity on the trend and market morbidity dynamics of 2025, as well as the insights embedded in that data that foreshadow 2026 dynamics. We have integrated this view into our 2026 refiling decisions and are making excellent progress against our goal to reprice 100% of the Marketplace book.

雖然上個月對這項業務來說極具挑戰性，但團隊對 2025 年的趨勢和市場發病率動態以及數據中預示 2026 年動態的見解有了更加清晰的認識。我們已將這一觀點融入 2026 年的重新備案決策中，並且在實現 100% 市場帳簿重新定價的目標方面取得了巨大進展。

In Medicaid, we now have far more transparency about the drivers of cost and trend across our portfolio and are in command of the levers to correct our HBR trajectory as we head into 2026 and beyond. With 88% of the book rerating over the next 6 months, momentum around policy changes and enterprise-aligned execution on key initiatives, we are confident we can meaningfully move the Medicaid HBR in the right direction over the next 12 to 18 months.

在醫療補助方面，我們現在對整個投資組合的成本和趨勢驅動因素有了更大的透明度，並且在邁向 2026 年及以後的過程中，我們能夠掌握糾正 HBR 軌蹟的槓桿。隨著未來 6 個月內 88% 的帳面價值重新評級、政策變化的勢頭以及關鍵舉措的企業一致執行，我們有信心在未來 12 到 18 個月內，我們可以有效地推動 Medicaid HBR 朝著正確的方向發展。

And finally, armed with strong rates and operating discipline, our Medicare Advantage business will continue to make solid progress in 2026 on its path to breakeven in 2027. Our industry is always evolving, and it is our job as a business to evolve with it. We have spent the last three years fortifying our platform. And over the coming months, we will pressure-test each of our markets for the future conditions necessary to support sustainable, profitable growth.

最後，憑藉強大的利率和營運紀律，我們的醫療保險優勢業務將在 2026 年繼續取得穩步進展，並在 2027 年實現收支平衡。我們的產業一直在不斷發展，身為企業，我們的職責就是隨之發展。我們花了三年時間鞏固我們的平台。在接下來的幾個月裡，我們將對每個市場進行壓力測試，以了解支持可持續獲利成長所需的未來條件。

We will harvest additional synergies across the platform, lean harder into places we can leverage our unique size and scale and work to ensure we have the strongest and most resilient platform to support the new normal that lies ahead. To that end, a comment on the policy and legislative landscape.

我們將在整個平台上獲得更多的協同效應，更加努力地利用我們獨特的規模和範圍，並努力確保我們擁有最強大、最具彈性的平台來支援未來的新常態。為此，對政策和立法狀況進行評論。

We view OB3 as having established a new and stable policy floor for our programs, and we are actively developing a multiyear implementation strategy. Many of the Medicaid provisions include runway for implementation, allowing us to leverage the strong partnerships we have at the state level to help maximize the impact of taxpayer dollars and maximize coverage for vulnerable members.

我們認為 OB3 為我們的計畫建立了新的、穩定的政策基礎，我們正在積極制定多年實施策略。許多醫療補助條款都包含實施平台，使我們能夠利用州一級的強大合作夥伴關係，最大限度地發揮納稅人資金的作用，並最大限度地覆蓋弱勢群體。

On the Marketplace side, as you heard, we have the benefit of an early look at program integrity impacts and are baking that into our revised 2026 pricing. While we expect to see a contraction of the individual market heading into 2026, regardless of what happens with eAPTCs, just on the other side of that is a more stable market for individual and family coverage.

在市場方面，正如您所聽到的，我們可以提前了解專案完整性的影響，並將其納入我們修訂後的 2026 年定價中。儘管我們預計到 2026 年個人保險市場將會萎縮，無論 eAPTC 發生什麼，但另一方面，個人和家庭保險市場將會更加穩定。

Medicare likely has another wave of policy changes coming from CMS aimed at maximizing efficiency and integrity across the program, and we are tracking those closely as we build back that business. This clarity allows us to firmly plan for the future. And our confidence in the staying power of Medicaid, Medicare and the individual marketplace is as strong as it has ever been.

醫療保險可能會面臨來自 CMS 的另一波政策變化，旨在最大限度地提高整個計劃的效率和完整性，我們在重建業務的過程中正在密切關注這些變化。這種清晰的認識使我們能夠堅定地規劃未來。我們對醫療補助、醫療保險和個人市場的持久力的信心一如既往地強烈。

By staying focused and delivering on our mission of transforming the health of the communities we serve one person at a time, we believe we can command a durable, differentiated position in a key market and deliver meaningful value to our members, our stakeholders and our shareholders.

透過保持專注並履行我們的使命，即每次為每個人服務，從而改善社區的健康狀況，我們相信我們可以在關鍵市場中佔據持久的差異化地位，並為我們的會員、利害關係人和股東提供有意義的價值。

With that, let me turn it over to Drew for some additional detail on the financial results.

接下來，讓我將問題交給德魯，讓他詳細介紹財務結果。

Thank you, Sarah. Today, we reported second quarter 2025 results, including $42.5 billion in premium and service revenue, and a disappointing adjusted diluted loss per share of $0.16. Let me build on what Sarah covered regarding what happened and, more importantly, what actions we are taking.

謝謝你，莎拉。今天，我們公佈了2025年第二季的業績，其中包括425億美元的保費和服務收入，以及令人失望的每股0.16美元的調整後攤薄虧損。讓我結合莎拉之前提到的情況，更重要的是，我們正在採取的措施，進一步闡述。

Let's start with Marketplace, where Sarah covered a lot of ground. So let me give you a click deeper into one of the primary drivers observed in the data we received in late June and then tie that to the relevance for refiling 2026 rates.

讓我們從 Marketplace 開始吧，Sarah 在該領域涉及了很多領域。因此，讓我帶您更深入地了解我們在 6 月底收到的數據中觀察到的主要驅動因素之一，然後將其與重新提交 2026 年利率的相關性聯繫起來。

We have found a high correlation between increasing 2025 morbidity in a given geography and the degree to which there is disruption in the two low-cost silver plans from 2024 to 2025 and whether or not that geography was in a state-based exchange or federal exchange for those two years.

我們發現，特定地區 2025 年發病率的增加與 2024 年至 2025 年兩項低成本白銀計劃的中斷程度以及該地區在這兩年是否處於州級交易所或聯邦交易所之間存在高度相關性。

In other words, where there was a change in the two low-cost silver plans in the federally facilitated exchange, which would require the member to take an action in order to maintain a $0 premium, we believe the 2025 program integrity provisions, such as a three-way call with CMS or social security verification, negatively shifted the risk pool and disproportionately reduced 0 or low utilizers from the market in 2025.

換句話說，如果聯邦政府促成的交易所中的兩個低成本白銀計劃發生變化，這將要求會員採取行動以維持 0 美元的保費，我們認為 2025 年計劃完整性條款（例如與 CMS 的三方通話或社會保障驗證）會對風險池產生負面影響，並在 2025 年不成比例地減少市場上 0 或低利用率的用戶。

This same phenomenon appears to have also reduced the entry of similar new members across all federally facilitated exchange, or FFE, markets compared to 2024. As Sarah mentioned, the morbidity increase was up as much as 17% in states with significant low-cost silver disruption. Conversely, in an FFE geography with no disruptions in the two low-cost Silver plans, the members could auto-renew with their carrier for 2025 without much of a hassle.

與 2024 年相比，同樣的現像似乎也減少了所有聯邦促進交易所（FFE）市場中類似新成員的進入。正如莎拉所提到的，在低成本白銀供應嚴重中斷的州，發病率上升了 17%。相反，在兩個低成本銀計劃沒有中斷的 FFE 地區，會員可以輕鬆地與其運營商自動續訂 2025 年的計劃。

Why is this important? Because based on what we can see across our 29-state footprint, we can form an expectation of what degree of morbidity lift may be coming in 2026 when all members will have to go through the new program integrity steps and validations to ensure eligibility for 2026 Marketplace. This has meaningfully influenced our 2026 pricing approach that Sarah described.

為什麼這很重要？因為根據我們在 29 個州的足跡所看到的情況，我們可以預期 2026 年發病率可能會上升到何種程度，屆時所有成員都必須經過新的計劃完整性步驟和驗證，以確保有資格參加 2026 年市場。這對 Sarah 所描述的 2026 年定價方法產生了重大影響。

As of this morning, we have submitted 17 re-filings and expect to wrap up the remaining states in the next week or so, with the approval process expected in August. As we sit here today, we expect to make meaningful upward 2026 rate adjustments reflecting this data across our Marketplace footprint.

截至今天上午，我們已經提交了 17 份重新申請，預計將在下週左右完成剩餘州的申請，批准程序預計將在 8 月完成。今天，我們期望對 2026 年的利率做出有意義的上調，以反映我們整個市場範圍內的這些數據。

In Medicaid, Sarah covered the trend drivers, including the acceleration of behavioral health, especially ABA and other related counseling therapies in Q2. We are working with state partners to get rates corrected for this and, in some cases, push for retro premium adjustments for program changes such as Florida Children's Medical Service where we are the sole source carrier and where there are inadequate risk adjustment mechanisms such as in New York.

在醫療補助方面，莎拉介紹了趨勢驅動因素，包括行為健康的加速發展，特別是第二季的 ABA 和其他相關諮商療法。我們正在與州合作夥伴合作，以糾正這一費率，並且在某些情況下，推動對計劃變更進行保費的追溯調整，例如在佛羅裡達兒童醫療服務中，我們是該服務的唯一來源承運人，並且在紐約等風險調整機制不足的地方。

In addition to the 7/1 and 9/1 positive rate updates Sarah provided, we are working with our state partners to drive policy improvements across a number of states. One example being pharmacy management responsibility returning to the Medicaid plans in one of our states in the fourth quarter, which will allow us to directly manage the cost. We're also executing on initiatives designed to keep health care affordable, including clinical interventions, payment integrity and choosing the right network partners.

除了莎拉提供的 7 月 1 日和 9 月 1 日的積極利率更新外，我們還在與州合作夥伴合作，推動多個州的政策改進。其中一個例子是，藥房管理責任在第四季度回歸到我們某個州的醫療補助計劃，這將使我們能夠直接管理成本。我們也正在實施旨在維持醫療費用可負擔的舉措，包括臨床幹預、支付完整性和選擇合適的網路合作夥伴。

Let me go a little bit deeper on PDP as a follow-up from the Q1 call. Now that we have two quarters of PDP data, we can better forecast the trends for the remainder of the year. Even though we still see very high specialty pharmacy trends in our non-low-income cohort, we are into the 90% CMS, 10% payer part of the risk corridor.

作為 Q1 電話會議的後續，讓我更深入地討論 PDP。現在我們有了兩個季度的 PDP 數據，我們可以更好地預測今年剩餘時間的趨勢。儘管我們在非低收入者中仍然看到非常高的專業藥局趨勢，但我們處於 90% CMS、10% 付款人的風險走廊部分。

This should provide us with earnings protection and reasonable predictability, though we will continue to build a receivable from CMS, which will be increasingly visible in our cash flows in the back half of the year. And as Sarah mentioned, our Medicare Advantage business is ahead for 2025 and on track for our goal to breakeven in 2027.

這應該能為我們提供獲利保障和合理的可預測性，儘管我們將繼續從 CMS 建立應收帳款，這將在今年下半年的現金流中越來越明顯。正如莎拉所提到的，我們的醫療保險優勢業務將在 2025 年取得進展，並預計在 2027 年實現收支平衡。

Moving to consolidated enterprise topics. Cash flow provided by operations was $1.8 billion for Q2, primarily driven by improved timing on pharmacy rebate remittances. Unregulated cash on hand at quarter-end was $234 million. We do not have any further 2025 share buyback in our current forecast, but we'll remain open to opportunistic buybacks as we continually assess market conditions and changes in our cash positions.

轉向合併企業主題。第二季經營活動產生的現金流為 18 億美元，主要由於藥品回饋匯款時間的改善。季度末庫存非管制現金為 2.34 億美元。我們目前的預測是 2025 年不會進行任何進一步的股票回購，但隨著我們不斷評估市場狀況和現金狀況的變化，我們將繼續對機會性回購持開放態度。

Our medical claims liability at quarter-end represents 47 days in claims payable, a decrease of 2 days as compared to the first quarter of 2025, driven by the timing and types of claims as well as the impact of state-directed payments. And as a reminder, 2025 DCP is structurally lower than 2024 DCP due to our PDP revenue increase resulting from the Inflation Reduction Act and the speed at which pharmacy claims complete compared to medical claims.

我們季度末的醫療索賠責任代表應付索賠為 47 天，與 2025 年第一季相比減少了 2 天，這是受索賠時間和類型以及國家指示支付的影響所致。需要提醒的是，由於《通貨膨脹削減法案》導致我們的 PDP 收入增加，以及藥房索賠完成速度相對於醫療索賠的速度加快，2025 年 DCP 在結構上低於 2024 年 DCP。

Moving to our outlook for 2025. With the visibility we gained in Q2, we pressure-tested each business, operational measures, trend drivers and SG&A. The result is a forecast that equals $1.75 per diluted share of adjusted earnings with swing factors on both sides, as Sarah laid out.

展望 2025 年。憑藉我們在第二季度獲得的可見性，我們對每個業務、營運指標、趨勢驅動因素和銷售、一般及行政費用進行了壓力測試。如莎拉所述，預測結果相當於每股稀釋調整收益 1.75 美元，其中雙方都有波動因素。

A few more miscellaneous items that might answer a couple of questions in advance. One, we expect our full year adjusted tax rate in our forecast to be around 19%, which could vary depending on the actual level of pretax earnings. Two, given our market cap change, coupled with the passing of the OB3 in July, we will be going through a goodwill evaluation and test in the third quarter, which prevents us from being able to reconcile prospective adjusted EPS elements to a GAAP equivalent.

還有一些雜項可能會提前回答幾個問題。第一，我們預計全年調整後的稅率將在19%左右，具體數字可能會根據實際稅前收益水準而有所不同。二，鑑於我們的市值變化，再加上 7 月份 OB3 的通過，我們將在第三季度進行商譽評估和測試，這使得我們無法將預期的調整後每股收益要素與 GAAP 等值要素進行協調。

And three, our premium and service revenue outlook for 2025 has increased to approximately $172 billion, including approximately $89 billion in our Medicaid segment, $41 billion in our Commercial segment, $37 billion in the Medicare segment and $5 billion in Other. There is substantial future earnings power in this revenue base.

第三，我們對 2025 年的保費和服務收入預期已增至約 1,720 億美元，其中醫療補助部門約 890 億美元，商業部門 410 億美元，醫療保險部門 370 億美元，其他部門 50 億美元。此收入基礎具有巨大的未來獲利能力。

Coming back to the big picture. There's a real opportunity to make meaningful margin improvements, and these are good long-term businesses. Yes, we have to navigate a major unanticipated shift in the marketplace risk pool in 2025, as well as the dislocation between Medicaid rates and underlying medical costs plus regulatory changes in 2026 and beyond. But these are important and relevant long-term businesses critical to serve and provide value to economically-challenged and medically-complex members and our government partners. This is fixable. We look forward to demonstrating improvements ahead.

回到大局。這是一個真正有機會實現利潤率的大幅提高，而且這些都是良好的長期業務。是的，我們必須應對 2025 年市場風險池的重大意外轉變，以及醫療補助費率和基本醫療成本之間的錯位以及 2026 年及以後的監管變化。但這些都是重要且相關的長期業務，對於為經濟困難和醫療複雜的成員以及我們的政府合作夥伴提供服務和價值至關重要。這是可以修復的。我們期待未來能夠取得進步。

Thank you for your interest in Centene. And Rocco, please open it up for questions.

感謝您對 Centene 的關注。羅科，請大家開放提問。

(Operator Instructions)

（操作員指示）

Josh Raskin, Nephron.

喬許·拉斯金（Josh Raskin），Nephron。

Hi. Thanks. I'm sure there'll be a lot on the operation. So I'm going to ask if you could walk us through your capital position, sort of the amount of capital that you think you'll be adding to your subsidiaries in the second half? And maybe how you're thinking about any potential needs for additional capital, whether that's debt or equity, through the rest of the year?

你好。謝謝。我確信會有很多關於這次手術的事情。所以我想問您是否可以向我們介紹一下您的資本狀況，例如您認為下半年會為您的子公司增加多少資本？也許您正在考慮今年剩餘時間內是否有任何額外的資本需求，無論是債務還是股權？

Yeah. Thanks, Josh. We have a very thoughtful plan on that. So I will let Drew walk through a couple of those items.

是的。謝謝，喬希。我們對此有一個非常周到的計劃。因此，我將讓德魯介紹其中的幾項內容。

Yeah. You'll see this in the Q, Josh. We think we'll need to put a net $300 million into our subs in the back half of the year. That's net of dividends that we still expect. Obviously, those dividends will be at a lower level than previously expected.

是的。你會在 Q 中看到這一點，喬希。我們認為我們需要在今年下半年向我們的潛艇投入 3 億美元的淨資金。這是我們仍預期的股利淨額。顯然，這些股利將低於先前預期的水平。

But stepping back to the big picture, you may recall that in the first quarter, we renewed our credit facility and we doubled the size of that. So it's a $4 billion credit facility. We had 0 drawn at June 30. And there's only one covenant in there, which is a 60% debt to cap, and we're currently about 39%. So we've got quite a bit of runway for capital and look forward to improving the operation and generating a higher level of earnings in 2026.

但回顧整體情況，您可能還記得，在第一季度，我們更新了信貸額度，並將其規模擴大了一倍。所以這是一筆 40 億美元的信貸額度。截至 6 月 30 日，我們已抽取 0 份。其中只有一個契約，即 60% 的債務上限，而我們目前約為 39%。因此，我們有相當大的資本儲備，並期待在 2026 年改善營運並創造更高的獲利水準。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Thanks. Just might try to drill down on some of your comments around the public exchanges. First, on the risk adjustment true-up or miss, whatever you want to call it. You're such a big part of the market. You were seeing some of these program integrity impacts as well as the underlying trend step-up. You -- is the right interpretation you thought those were applying to you, but not to the broader market, and therefore, it's only now that you're adjusting your expectations around the true-up?

謝謝。只是想嘗試深入了解您對公開交流的一些評論。首先，關於風險調整，無論你怎麼稱呼它，都是正確或錯誤。你是市場的重要組成部分。您看到了一些程序完整性影響以及潛在趨勢的增強。您—您認為這些正確的解釋適用於您，但不適用於更廣泛的市場，因此，您現在才根據實際情況調整您的預期？

And then broadly about next year, I know the repricing of 100% of the book. Can you just update us on your thought about what are you repricing to? What is the updated thought on target margins for the exchange and the environment we're going to see next year. And is there any way to comment on what that might mean for disenrollment from the exchanges? Maybe if not specifically for you, for the broad market, what are you assuming?

大致來說，明年，我知道 100% 的書的重新定價。您能否告訴我們您對重新定價的想法？對於交易所的目標利潤率以及明年我們將看到的環境，您有什麼最新的想法？有什麼方法可以評論這對於取消交易所資格意味著什麼嗎？也許，如果不是專門針對您，而是針對整個市場，您會假設什麼？

Yeah. Thanks, AJ. A lot of good questions in there. So thinking about open enrollment 2025, we -- I think one of the important factors in terms of assumptions is looking at new member sign-ups and then the effectuation rate. As we came through that process, we saw very strong effectuation rates, very consistent with what we had seen in the past.

是的。謝謝，AJ。其中有很多好問題。因此，考慮到 2025 年的開放註冊，我認為假設的一個重要因素是查看新會員註冊人數，然後查看實施率。當我們經歷這個過程時，我們看到了非常強勁的效果率，與我們過去所看到的非常一致。

And while we were certainly aware of the program integrity measures as a net grower in the market, I think it was not necessarily as clear to us that there were a lot of low or non-utilizing members that were being shifted out of the market, and that is a result of those program integrity measures.

雖然作為市場中的淨增長者，我們當然知道計劃完整性措施，但我認為我們並不一定清楚，有很多低利用率或未利用的成員正在被轉移出市場，而這是這些計劃完整性措施的結果。

And as Drew said, in some of those markets where the -- more members had to shop because of this the low-cost silver position, more members then were put through those program integrity filters and left the market. So I think having the full view of the market data, what we're really operating on up until that first set of Wakely data is our own information. But having the full view and understanding that I think a number of other carriers probably shed members, and instead of those members going to other carriers, they actually left the market. And that's really what drove a significant morbidity shift, again, average 8% to 9% across the market.

正如德魯所說，在某些市場中，由於低成本的白銀地位，更多的會員不得不購物，更多的會員隨後通過了這些計劃完整性過濾器並離開了市場。因此，我認為，在全面了解市場數據之後，直到我們獲得第一組 Wakely 數據之前，我們真正運用的都是我們自己的資訊。但從全面的角度和理解來看，我認為許多其他航空公司可能也在流失會員，而這些會員並沒有轉投其他航空公司，而是離開了市場。這才是真正推動發病率發生顯著變化的原因，整個市場的發病率平均上升了 8% 至 9%。

As we think about repricing, it's the point that Drew made in some of those insights and sort of the signal in the noise of the '25 data is really, really important, and understanding that the impact of the mobility shift was actually different market by market. And being able to see 29 markets and understand the different cohorts allows us to understand that there are some markets that didn't actually go through that full impact in 2025 but will go through that impact in 2026 when the program integrity measures that are being put in place will be applied ubiquitously.

當我們考慮重新定價時，德魯在一些見解中提出的觀點以及 25 年資料雜訊中的訊號非常非常重要，並且要理解流動性轉變的影響實際上因市場而異。透過觀察 29 個市場並了解不同的群體，我們可以了解到，有些市場實際上在 2025 年並沒有受到全面影響，但會在 2026 年受到影響，屆時正在實施的計劃完整性措施將得到廣泛應用。

So keeping that in mind, those are baked into our assumptions for re-filing for 2026. We obviously are expecting to improve profitability in the book for 2026, but we won't be able to comment on target margins until we see a little bit more of the full landscape, which will come in the M&A file in September. So stay tuned on that.

因此，記住這一點，這些都已納入我們對 2026 年重新提交的假設中。我們顯然希望在 2026 年的帳面上提高獲利能力，但直到我們看到更全面的情況後，我們才能對目標利潤率發表評論，這將在 9 月的併購文件中公佈。請繼續關注。

Relative to disenrollments for 2026 and sort of overall market contraction, again, the commentary on what we saw in those markets that were most disrupted in 2025, I think, are really not just a foreshadowing of what's going to happen in 2026. But I actually think what we experienced in 2025 was, in some ways, a pull forward of the impact that we would have otherwise expected in 2026, which means that we have already absorbed some of the market contraction that we would have otherwise estimated for 2026.

相對於 2026 年的取消註冊和整體市場萎縮，我認為，我們對 2025 年受干擾最嚴重的市場所看到的情況的評論，實際上不僅僅是對 2026 年將要發生的事情的預示。但實際上我認為，從某種程度上來說，我們在 2025 年經歷的影響是我們原本預計在 2026 年發生的影響的提前，這意味著我們已經吸收了我們原本預計在 2026 年發生的部分市場萎縮。

So again, also baking that into our assumptions pricing based on an expectation of law of the land. So accounting for the fact that enhanced eAPTCs would expire. And again, all of that is sort of being put into the re-filings and the additional pricing that we have submitted. And I think, again, making very good progress on that. The states have been very receptive digesting the data. And we believe we've got a path to reprice 100% of the Marketplace book for profitability in '26.

因此，我們再次將其納入基於對國家法律的預期的定價假設中。因此考慮到增強型 eAPTC 將會過期的事實。再次強調，所有這些都被納入我們已提交的重新備案和額外定價中。我認為，在這方面我們再次取得了非常好的進展。各州都非常樂意消化這些數據。我們相信，我們已經找到了一種方法，可以對 100% 的 Marketplace 帳簿進行重新定價，以實現 26 年的利潤。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. First, just a quick follow-up from your answer to Josh's question. I think I heard Drew say that you expect to generate higher earnings in 2026. Just wanted to confirm that and any color. And then my question is on Medicaid. Your guidance for the second half of the year implies 140 basis points of improvement from the 94.9% you reported in 2Q.

謝謝。首先，我只是想快速跟進一下您對 Josh 的問題的回答。我想我聽到德魯說過，你預計 2026 年的收益會更高。只是想確認這一點和任何顏色。我的問題是關於醫療補助的。您對下半年的預測意味著比第二季報告的 94.9% 提高 140 個基點。

It's fairly differentiated in terms of the slope versus your two peers who are actually assuming Medicaid deteriorates from the second half versus Q2. So I'm just curious, Drew, is there anything in your second quarter reported MLRs such as negative intra-year development that might make it the wrong jump-off point, or anything else we should consider in terms of 2Q versus the back half that might be different versus your peers? Thanks.

與其他兩位同業相比，其斜率有相當大的差異，他們實際上假設醫療補助從下半年開始相對於第二季會惡化。所以我很好奇，德魯，您報告的第二季度 MLR 中是否存在什麼內容，例如年內發展為負數，這可能會使其成為錯誤的起點，或者我們應該考慮第二季度與下半年相比可能與您的同行有所不同的其他內容？謝謝。

Yeah. Thanks, Justin. So both Drew and I talked about the fact that we expect to deliver margin improvement in all three lines of business in 2026 and, therefore, earnings improvement. So obviously, too early to talk about guidance for 2026, but we've talked about sort of the progress that we expect to make in each of the lines of business. Let me talk about Medicaid specifically because that's obviously a big piece of it and break down sort of what we saw in Q2 a little bit more and how that relates to how we think about the back half of the year.

是的。謝謝，賈斯汀。因此，德魯和我都談到了這樣一個事實：我們預計到 2026 年，所有三個業務線的利潤率都會提高，從而盈利也會提高。顯然，現在談論 2026 年的指導還為時過早，但我們已經討論了我們期望在各個業務線上取得的進展。讓我具體談談醫療補助，因為這顯然是其中很重要的一部分，並進一步分析我們在第二季度看到的情況，以及這與我們對下半年的看法有何關聯。

So obviously, not pleased with the 94.9%. But if we break it down a little bit more, as I said, what drove that was an acceleration of trend in the quarter in those three areas. So behavioral health, which is about 50%, with ABA as sort of a primary driver underneath that. Home health is about 30% of the total. Again, HCBS is sort of the big category, and then high cost drugs was the rest.

顯然，我對 94.9% 這個數字並不滿意。但如果我們進一步細分，正如我所說，推動這一趨勢的原因是本季這三個領域的趨勢加速。行為健康約佔 50%，而 ABA 是其主要驅動力。家庭保健約佔總量的30%。再次強調，HCBS 是一個大類別，其餘的都是高成本藥物。

Important to note that we aren't seeing broad-based trends. So inpatient looks fine, ED looks fine, PCP is right on track. We also saw a concentration of that trend acceleration in a small handful of states. So we've got a small number of Phase 2 that we called out Florida and New York that really account for the majority of the miss in Q2. As an example, Florida alone accounted for 40 basis points of HBR pressure in the quarter.

值得注意的是，我們並沒有看到廣泛的趨勢。因此住院病人看起來不錯，ED 看起來不錯，PCP 一切正常。我們也看到這種趨勢在少數州集中加速。因此，我們在第二階段中只得到了少量數據，其中佛羅裡達州和紐約州的數據確實佔了第二季大部分數據缺失的原因。例如，僅佛羅裡達州一地就在本季造成了 40 個基點的 HBR 壓力。

So we are really able to be focused and organized around those states even more intensively in terms of pulling levers. Obviously, pulling them across all states and taking an enterprise-wide approach, but really focused on being able to drive outsized impact in that select number of geographies. Those levers include appropriate utilization management, helping states understand where they've got opportunities relative to clear clinical policy guidelines. This is a big thing in both HCBS and behavioral health. States are still sort of evolving their perspective on what appropriate dose duration looks like.

因此，在拉動槓桿方面，我們確實能夠更加集中精力並圍繞這些州進行組織。顯然，將它們拉到所有州並採取全企業範圍的方法，但真正專注於能夠在選定的幾個地區產生巨大的影響。這些槓桿包括適當的利用管理，幫助各州了解他們在哪些方面有機會獲得明確的臨床政策指引。這對 HCBS 和行為健康來說都是一件大事。各州對於適當的劑量持續時間的看法仍在不斷演變。

We're optimizing networks, ensuring that we've got highest-quality providers. We're aligning members to those providers. And then pretty aggressively stamping out fraud, waste and abuse, which is not talked about as much, but we are seeing a much higher prevalence of that in the behavioral health base, partly because of the fragmented provider base. And then, of course, advocating for rates.

我們正在優化網絡，確保我們擁有最高品質的提供者。我們正在將會員與這些提供者進行協調。然後非常積極地杜絕詐欺、浪費和濫用，雖然這些很少被談論，但我們看到這些現像在行為健康領域更為普遍，部分原因是提供者群體分散。然後，當然，還要倡導利率。

So while some of these things do take time to show up in the results, we are seeing progress. And again, if we go through just that handful of states that account for the majority of the miss, in Florida, the continuity of care provision lifted 6/1. We're obviously advocating aggressively for rates both retroactively and prospectively to address the rate gap. In New York, we've got a clear road map. We're seeing progress there on a number of fronts, including really good support from the state to go after fraud, waste and abuse.

因此，儘管其中一些事情確實需要時間才能在結果中顯現出來，但我們正在看到進展。再說一次，如果我們只看佔大多數的少數州，在佛羅裡達州，護理服務的連續性提高了 6/1。我們顯然積極主張透過追溯和前瞻性的利率來解決利率差距問題。在紐約，我們有清晰的路線圖。我們看到許多方面都取得了進展，包括政府在打擊詐欺、浪費和濫用行為方面提供的大力支持。

And then in two of the other states, those states both sit in the 7/1 to 9/1 in cohort and both got important and healthy rate updates that do take current trend into account. One of them is also the state that Drew referenced that has made a move away from the single PBM model. And so as of 10/1, we'll be able to get them over to ESI and leverage our cost structure.

然後在其他兩個州，這兩個州都處於 7/1 到 9/1 的區間，並且都獲得了重要且健康的利率更新，這些更新確實考慮到了當前的趨勢。其中之一也是德魯提到的已經放棄單一 PBM 模式的州。從 10 月 1 日起，我們將能夠將它們轉移到 ESI 並利用我們的成本結構。

So I think being able to move the needle in a pretty concentrated way, obviously, also pushing across the portfolio. But for context, about a third of our health plans are outperforming their original HBR targets year-to-date. So we do have a pretty healthy portion of the book. We know where to focus in terms of where to significantly move the needle. I think we know what to do. We're aggressively getting after it.

因此，我認為能夠以相當集中的方式推動這一進程，顯然也能推動整個投資組合。但就背景而言，今年迄今為止，我們約有三分之一的健康計畫的表現超出了最初的 HBR 目標。所以我們確實有相當一部分書的內容。我們知道應該把重點放在哪裡，才能有顯著進展。我想我們知道該怎麼做。我們正在積極地追求它。

And so taking a step back, that is really the momentum that gives us confidence that, over the next four to six quarters, we'll be able to deliver meaningful margin improvement in Medicaid, and that informs the view of the back half as well.

因此，退一步來說，這確實是一個讓我們有信心的勢頭，在接下來的四到六個季度裡，我們將能夠在醫療補助方面實現有意義的利潤改善，這也為下半年的觀點提供了參考。

David Windley, Jefferies.

傑富瑞的戴維溫德利 (David Windley)。

Hi. Thanks for taking my questions. I wanted to ask on kind of the Wakely data of membership trend, if implied in the Wakely data, that you called out in your pre-announcement, kind of said that the market attrition had been more of the growth. I guess you called it the growth was smaller in the market. Can you talk about what the market size is today? What assumptions you are making about further attrition over the balance of the year and, therefore, further shift in morbidity over the balance of the year, please?

你好。感謝您回答我的問題。我想問 Wakely 的會員趨勢數據，如果 Wakely 數據中暗示了這一點，那麼您在預先公告中提到，市場流失率超過了成長率。我想你會說這是市場成長較小。能談談目前的市場規模嗎？請問您對今年剩餘時間的進一步人員流失以及因此今年剩餘時間的發病率進一步變化做出了什麼假設？

Yeah, absolutely. So you're right. We called out the fact that the Wakely data is really the first time that we have an empirical view of what the total market is doing. And the overall growth in the market, now obviously, it's different state by state, but the overall growth in the market was lower than, for example, what CMS had put out at the beginning of the year in terms of the 13.5% relative to sign-ups. So obviously, that means that the delta between sign-ups and infatuations was a lot bigger than it has been in past years.

是的，絕對是如此。所以你是對的。我們指出，韋克利的數據確實是我們第一次對整個市場的動向有了實證的看法。現在，市場的整體成長顯然因州而異，但整體市場的成長低於 CMS 在年初公佈的註冊量 13.5% 的成長水平。顯然，這意味著註冊人數和迷戀人數之間的差距比過去幾年要大得多。

And this is not fully validated in the Wakely data, I think we'll have a better view of that as we get the tranches in September and December. But based on what we can triangulate, our view is that the market actually contracted during open enrollment in 2025 and likely is continuing to contract month over month as we go through the year.

這在 Wakely 數據中尚未得到充分驗證，我認為當我們獲得 9 月和 12 月的數據時，我們對此有更好的了解。但根據我們的三角測量結果，我們的觀點是，市場實際上在 2025 年開放招生期間已經萎縮，並且很可能會在全年繼續逐月萎縮。

For our part, we are expecting further attrition in 2025. So we're sitting at 5.9 million members today. We expect to end the year at 5.4 million members. Part of that is driven by the FTR, failure to report, PDM, which we talked about back in -- on the Q4 call, because I think everybody anticipated that, that would -- those impacts would be taken in open enrollment. They actually got shifted to the summertime frame.

就我們而言，我們預計 2025 年還會進一步減少員工人數。所以今天我們的會員人數是 590 萬人。我們預計今年底會員人數將達到 540 萬人。部分原因是由於 FTR（未報告）和 PDM，我們在第四季度電話會議上討論過這個問題，因為我認為每個人都預料到，這些影響將在公開招生中顯現。他們實際上已經轉移到夏季時間了。

As we look at the files that are coming in for August 1, we believe we're seeing the first wave of FTR starting to get implemented. So we think that will drive further membership attrition over the back half of the year and have accounted for the idea that, that may also drive some morbidity shifts, although I don't think we see a huge delta in that population. But again, very cognizant of that given what we saw in Wakely and what it could do for the rest of the year.

當我們查看 8 月 1 日即將收到的文件時，我們相信我們將看到第一波 FTR 開始實施。因此，我們認為這將導致下半年會員人數進一步減少，並且我們認為這也可能導致一些發病率的變化，儘管我認為我們不會看到該族群出現巨大的差異。但是，鑑於我們在韋克利所看到的情況以及它在今年剩餘時間內可能產生的影響，我們非常清楚這一點。

And then, of course, we expect further attrition in the 2026 open enrollment. And whether you're doing math on eAPTCs in or out, if you look at some of the public sources, the numbers that have been thrown out there, anywhere from 15% to 50%. I think the higher end of that probably ignores what we saw in 2025 in terms of being a pull forward of market contraction into the 2025 year. And the bottom end of that probably undershoots the impact of the program integrity measures based on what we've seen, and obviously, assumes the APTs continue.

當然，我們預計 2026 年公開招生時學生人數還會進一步減少。無論您是否對 eAPTC 進行計算，如果您查看一些公共來源，您會發現其中的數字在 15% 到 50% 之間。我認為，這個數字的上限可能忽略了我們在 2025 年看到的情況，即市場萎縮提前到 2025 年。根據我們所看到的情況，這一結果的底線可能低於程序完整性措施的影響，並且顯然假設 APT 會繼續下去。

So I think somewhere in the middle of that range is probably a safe zone to assume. But we'll have a better view of that as we get further data in September and then understand the landscape file from competitors and have a little bit more precision from CMS on the exact process that's going to be in place for program integrity for 2026.

所以我認為該範圍中間的某個地方可能是可以假設的安全區域。但是，隨著我們在 9 月獲得更多數據，然後了解競爭對手的概況文件，並從 CMS 獲得有關 2026 年計劃完整性的具體流程的更精確的信息，我們將對此有更好的了解。

Lance Wilkes, Bernstein.

蘭斯威爾克斯、伯恩斯坦。

Can you talk a little bit about the risk adjustment payable? And in particular, what I'm interested in is, what's the strategy as you go into '26 and beyond to address kind of product structure and benefit structure to either reposition yourselves to be having a lower payable? Or are you going to be comfortable being a much higher payable player out there? What would be the other considerations as you go through that strategy with respect to membership and profitability? Thanks.

能稍微談談風險調整應付款項嗎？特別是，我感興趣的是，當你們進入 26 年及以後時，你們會採取什麼策略來解決產品結構和福利結構，以重新定位自己以降低應付金額？或者你願意成為薪水更高的球員嗎？在製定該策略時，您在會員和獲利能力方面還需要考慮哪些其他因素？謝謝。

Yeah. Thanks, Lance. It's a great question. So as we've been going through 2026 repricing, understanding that we've been operating under a very tight window to get all those re-filings in by the deadline, we are also taking into account sort of the macro dynamics of each market and thinking about the degree to which we'll be able to price for what we think the ultimate morbidity shift will be and where there may be opportunities or, frankly, mandates to sort of tweak our presence in a market that's thinking differently about product tiers, thinking differently about network partners. Because, again, the goal is to really maximize margin over membership in 2026.

是的。謝謝，蘭斯。這是一個很好的問題。因此，當我們進行 2026 年重新定價時，我們了解到我們一直在非常緊張的時間範圍內運作以便在截止日期前完成所有重新申報，我們也會考慮每個市場的宏觀動態，並思考我們能夠在多大程度上根據我們認為的最終發病率轉變進行定價，以及在哪些方面可能存在機會，或者坦率地說，需要調整我們在一個合作夥伴存在層次、對市場中存在的看法。因為，我們的目標是在 2026 年真正實現會員人數最大化。

And then I would say, as we think about 2027 and beyond, I'll make this comment for Marketplace, but I think it's true across the portfolio, is it's an opportunity for us to take a step back and make sure that we really have a portfolio in each line of business that is optimized for our goal of delivering sustainable margins over the long term. And so that will be a process that I think we can do as we step into 2026 and think about 2027 pricing.

然後我想說，當我們考慮 2027 年及以後時，我會對 Marketplace 做出這一評論，但我認為這對整個投資組合來說都是如此，這是我們退一步的機會，確保我們在每個業務線上都有一個真正針對我們實現長期可持續利潤率的目標進行優化的投資組合。因此，我認為當我們進入 2026 年並考慮 2027 年的定價時，我們可以進行這個過程。

Relative to the payable/receivable dynamic, that is obviously an inherent dynamic in the marketplace and one we're always being thoughtful about. I think one of the questions that we've spent a lot of time talking about, not just in light of the most current events, but just in general, is how we could leverage our size and scale as the largest player in the market to drive an additional level of transparency and also make sure that, where there are program improvements, to create stability overall, we're leaning into those?

相對於應付/應收帳款的動態，這顯然是市場固有的動態，也是我們一直在思考的動態。我認為我們花了很多時間討論的一個問題，不僅是考慮到最新的事件，而且是總體而言，就是我們如何利用我們作為市場最大參與者的規模來推動額外的透明度，並確保在有計劃改進的地方，創造整體穩定性，我們會傾向於這些？

So just two examples. One would be the opportunity to make some of the demographic data available earlier in the year, so think about immediately post open enrollment. And whether that's through CMS through the Departments of Insurance, through Wakely, really lending our data as sort of a first mover in that, and creating broader transparency for the entire market, I think, will allow people to make much better assumptions relative to risk adjustment going forward.

僅舉兩個例子。其中一個機會是在今年早些時候提供一些人口統計數據，因此請考慮在開放招生後立即提供。無論是透過醫療保險和醫療補助服務中心 (CMS)、保險部門還是 Wakely，將我們的數據作為其中的先行者，為整個市場創造更廣泛的透明度，我認為這將使人們能夠在未來的風險調整方面做出更好的假設。

And then the second would be working with the administration so that, where there are policy or process changes, that they are locked down before pricing is due. And so I think this is something that we see in Medicare that's more mature. But part of the program integrity changes that went into effect late last year were introduced after pricing. And so making sure that if there are going to be changes, that all carriers have visibility to those and can integrate them into their pricing is obviously going to drive more stability long term.

第二步是與政府部門合作，以便在政策或流程發生變化時，能夠在定價之前將其鎖定。所以我認為這是我們在醫療保險中看到的更成熟的東西。但去年年底生效的部分計劃完整性變化是在定價之後引入的。因此，確保如果發生變化，所有營運商都能了解這些變化並將其納入定價中，這顯然將帶來長期的穩定性。

So those are conversations that we're actively having and have thoughts on I think continue to just look at ways both in our own forecasting, but then also in how the market operates overall, we can ensure that this is a stable platform as possible because we do believe that it is a really important platform for individual and family coverage. And as we've talked about a lot before, we are very optimistic that it is actually sort of the ultimate platform for how individuals and families purchase health care coverage.

因此，這些都是我們正在積極進行的對話和思考，我認為我們會繼續研究我們自己的預測方式，同時也會研究整個市場的運作方式，我們可以確保這是一個盡可能穩定的平台，因為我們確實相信這是一個非常重要的平台，可以保障個人和家庭的保險。正如我們之前多次討論過的，我們非常樂觀地認為它實際上是個人和家庭購買醫療保險的終極平台。

And we can talk about the momentum we're seeing around ICHRA, the momentum we are driving around ICHRA, but obviously part of the exact same risk pool. So it's really important that we get the underlying programmatic elements right in order to make sure that we can grow that risk pool, which will ultimately bring down premiums, bring down cost of subsidy and create more affordable options for Americans.

我們可以談談我們在 ICHRA 周圍看到的勢頭，我們在 ICHRA 周圍推動的勢頭，但顯然它們屬於完全相同的風險池的一部分。因此，我們必須正確理解底層的計畫要素，以確保我們能夠擴大風險池，最終將降低保費，降低補貼成本，並為美國人創造更多可負擔的選擇。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Okay. Great. Thanks. I just wanted to go back to the Medicaid discussion. You made a number of comments about progress or substantial progress over the next 12 to 18 months. Does that mean that you don't expect to be back to target margins in Medicaid in 2027?

好的。偉大的。謝謝。我只是想回到醫療補助的討論。您對未來 12 到 18 個月的進展或實質進展發表了許多評論。這是否意味著您預計 2027 年醫療補助的利潤率不會恢復到目標水準？

And it sounds like a lot of what you're pointing to in the pressure in Medicaid is about cost trend. I think some of your peers have talked about risk pools changing as well. So just any color you have on that side? Because it does seem like there's going to be additional membership losses in Medicaid over the next several years, and whether you think that's going to be another difficulty in getting back to target margins in Medicaid. Thanks.

聽起來您所指出的醫療補助壓力很大程度上與成本趨勢有關。我認為您的一些同行也談到了風險池的變化。那麼那邊有什麼顏色嗎？因為看起來未來幾年醫療補助計劃的會員人數還會進一步減少，您是否認為這會為醫療補助計劃恢復到目標利潤率帶來另一個困難。謝謝。

Yeah, Kevin, thanks for the question, and welcome back. So we did -- I went through sort of a number of the levers that we're pulling around driving improvement in the overall Medicaid book. Again, focus in the areas where we've got trend, focus in those geographies.

是的，凱文，謝謝你的提問，歡迎回來。所以我們這樣做了——我仔細研究了我們正在採取的一系列措施，以推動整個醫療補助計劃的改善。再次強調，重點關注我們已發現趨勢的領域，並關注那些地理位置。

When I think about the momentum that we are seeing, and again, sort of take a step back, having sort of wrestled the tail of redeterminations over the last 18 months and then the step-up in trend, we continue to see progress in terms of our ability to have productive discussions with the states relative to rate, integrate more real-time data, have those actuaries thinking about how trend shifts and risk pool shifts can be more quickly integrated into the view. And I think we're seeing that in terms of both the rate increases that we've gotten as well as what we're seeing for 7/1 and 9/1 and continue to push going forward.

當我思考我們所看到的勢頭時，再次退一步，在過去 18 個月中，我們一直在努力應對重新確定的尾聲，然後是趨勢的上升，我們繼續看到我們在與各州就利率進行富有成效的討論、整合更多實時數據、讓精算師思考如何更快地將趨勢變化和風險池變化納入視野方面的能力取得進展。我認為，從我們已經獲得的加息以及 7 月 1 日和 9 月 1 日所見的情況來看，我們已經看到了這一點，並將繼續向前推進。

So the question is, to your point, is really when, not if. And I think as we think about the next couple of quarters, I think you introduced correctly the piece that we're going to want to be thoughtful about as we set the recovery trajectory for Medicaid, which is that as we move into 2027 and 2028, we will have, assuming they get upheld on the other side of midterms and implemented on time, we will have some of the OB3 impacts to consider. So things like work requirements, six-month verifications. And we do think that that will shift the risk pool slightly because it will cause members to lose coverage.

所以，正如您所說，問題實際上是何時發生，而不是是否發生。我認為，當我們考慮接下來的幾個季度時，您正確地介紹了我們在設定醫療補助恢復軌跡時需要深思熟慮的部分，也就是說，當我們進入 2027 年和 2028 年時，假設它們在中期選舉後得到支持並按時實施，我們將考慮 OB3 的一些影響。例如工作要求、六個月的驗證等。我們確實認為這會稍微改變風險池，因為這會導致會員失去保障。

Obviously, having gone through a version of redeterminations, we are smarter now about how that may shift the risk pool. But I think we want to take that into account as we think about both what the recovery trajectory is and what the long-term run rate is for HBR margins. But if you ask me over the next four to six quarters and as we think about '27 and beyond, are we going to improve the Medicaid margins? My answer is yes. And I think we have the ability to take into account those impacts and be thoughtful about not overshooting get into 2027 and 2028.

顯然，在經歷了一系列重新確定之後，我們現在對於如何轉移風險池有了更清晰的認識。但我認為，當我們考慮復甦軌跡和 HBR 利潤率的長期運行率時，我們要考慮到這一點。但如果你問我，在接下來的四到六個季度裡，當我們考慮 27 年及以後時，我們是否會提高醫療補助的利潤率？我的答案是肯定的。我認為我們有能力考慮到這些影響，並深思熟慮，避免在 2027 年和 2028 年出現過度增長。

But again, we continue to push hard on the various levers that we can control, and I think are seeing a different kind of conversation with the states about being more prospective in the rate setting. And, frankly, also thinking about the fact that in this kind of environment with the level of disruption that we've been going through and some of the additional changes that are forthcoming, that resetting rates in Medicaid on an annual basis probably doesn't make sense.

但是，我們將繼續大力推動我們能夠控制的各種槓桿，我認為我們正在與各州進行不同類型的對話，以便在利率制定方面更具前瞻性。坦白說，考慮到在這種環境下，我們所經歷的混亂程度以及即將發生的一些額外變化，每年重新設定醫療補助的費率可能沒有意義。

And so a number of states, although we don't talk about it a lot, a number of states actually do leverage a midyear rate cycle to address or assess where we stand. And I think we have seen, again, over the last two years, states leveraging more of those mid-cycle conversations to think about how trends are shifting in real time. And that is a place that we are leaning hard into from an advocacy standpoint, and I suspect that we will get support from our peers on that as well.

因此，儘管我們很少談論這個問題，但許多州實際上確實利用年中利率週期來解決或評估我們的現狀。我認為，在過去兩年中，我們再次看到各州利用更多中期對話來思考趨勢如何即時變化。從倡議的角度來看，這是我們大力推崇的，我相信我們也會得到同行的支持。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hi, thanks. I just wanted to follow up on Justin's question going from the second quarter MLR to the 93.5% for the back half. You gave us a pretty good sense on the rate side of things, but it seems like the vast majority of that needs to basically drop through with minimal cost growth in order to make that MLR achievable.

你好，謝謝。我只是想跟進賈斯汀的問題，從第二季的 MLR 到後半部分的 93.5%。您為我們提供了有關利率方面的很好的理解，但似乎絕大多數利率都需要以最小的成本增長來下降，才能實現 MLR。

I was just hoping you could talk a little bit more about the cost assumptions that you're making in the back half of the year. And then any kind of sense of what you're expecting in terms of membership in Medicaid for the rest of the year would also be helpful. Just wondering if you're planning for more attrition or any kind of impact on some of the CMS announcements we've gotten recently. Thank you.

我只是希望您能多談談您在下半年所做的成本假設。然後，了解您對今年剩餘時間內加入醫療補助計劃的期望也會有所幫助。只是想知道您是否計劃進行更多的人員減員或對我們最近收到的一些 CMS 公告產生任何影響。謝謝。

Yeah, sure. Thanks for the question. So obviously, rates are an important factor, but really, a lot of the other levers that I mentioned that are entirely in our control are important in terms of your question, the assumption on overall cost and what that will do. So if we think about what's built into the forecast, it is really assuming that sort of the level of trend that we have been seeing the accelerated trend will continue to some degree in the back half of the year.

是的，當然。謝謝你的提問。因此，顯然，利率是一個重要因素，但實際上，我提到的許多其他完全由我們控制的槓桿對於您的問題、整體成本的假設及其作用都很重要。因此，如果我們考慮預測中包含的內容，我們實際上假設我們所看到的加速趨勢將在今年下半年在一定程度上持續下去。

And that way, the improvements that we're making in terms of the levers we're pulling, optimizing networks, making sure that we've got the right clinical policy guidelines, appropriate utilization management, those are all opportunities to sort of further bend the trend. And then I'll let Drew talk a little bit about the membership assumptions that we have baked in for the back half.

這樣，我們在槓桿方面所做的改進，優化網絡，確保我們有正確的臨床政策指導方針，適當的利用管理，這些都是進一步扭轉趨勢的機會。然後，我會讓德魯稍微談談我們為後半部所製定的會員假設。

Yeah. Thanks for the question. And so let's start with rate first because you mentioned that. We're getting 5%, about 5%, and that's 29% of our revenue stream in the third quarter. That breaks down 20% on 7/1 and 9% on 9/1. And then we've got another 19% on 10/1 in terms of the proportion of the revenue for the year. And we think we've made a really prudent assumption there as we're pushing those 10/1 states for appropriate rate increases.

是的。謝謝你的提問。因為您提到了這一點，所以我們首先從利率開始。我們的利潤率為 5%，約 5%，這占我們第三季收入流的 29%。其中 7 月 1 日為 20%，9 月 1 日為 9%。然後，就全年收入比例而言，我們在 10/1 上又獲得了 19%。我們認為，在推動這 10/1 州適當提高利率時，我們做出了非常謹慎的假設。

On the cost side, when we take a look at the trajectory of net expense PMPMs, we've baked in over 4% lift in the second half of the year versus the first half of the year. So we think that's appropriate given what we've seen. And there's a lot of things that we're not betting on.

在成本方面，當我們查看淨費用 PMPM 的軌跡時，我們發現下半年與上半年相比增加了 4% 以上。因此，我們認為根據我們所看到的情況，這是合適的。還有很多事情我們不敢下注。

We're not baking in, including, I mentioned in my script, the Florida. We absolutely need and can justify and deserve a retro for the Children's Medical Services population. That is not in our forecast, as one example. And as well, some of the risk adjustment improvements that we need in the State of New York. So we've been really, we think, prudent with the back half forecast. But don't underestimate the power of that revenue coming in, the 88% between 7/1 and 1/1 of '26.

我們不會烘烤，包括我在劇本中提到的佛羅裡達。我們絕對需要、能夠證明並且值得對兒童醫療服務人群進行回顧。舉個例子，這不在我們的預測之內。此外，紐約州也需要進行一些風險調整改善。因此，我們認為，我們對下半年的預測確實非常謹慎。但不要低估這筆收入的力量，26 年 7 月 1 日到 1 月 1 日之間的收入佔比為 88%。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. Just wanted to follow up on the ACA outlook for next year. I think in the prepared remarks, you said that ACA was slightly below breakeven margins this year and you're targeting to restore that back to profitability, which I think could be interpreted as a very modest margin improvement. Then you later said that you're repricing for meaningful margin improvement. So can you, one, help clarify and level set the expectations for margin improvement next year? And maybe walk us through the framework for the range of outcomes on both margins and membership? Thanks.

嗨，早安。只是想了解一下明年的 ACA 前景。我認為在準備好的評論中，您說過 ACA 今年的利潤率略低於盈虧平衡點，而您的目標是恢復盈利，我認為這可以理解為利潤率的溫和提高。然後您後來表示，重新定價是為了顯著提高利潤率。那麼，第一，您能否幫助澄清和設定明年利潤率改善的預期？或許您可以向我們介紹一下利潤和會員範圍的結果架構？謝謝。

Sure. So you're right that we are expecting to operate slightly below breakeven for 2025. We are pricing to return to profitability in 2026. It is too early to understand whether -- what sort of that range will be. But as we thought about the re-filing and the pricing that we're putting in state by state, as I mentioned, we're very focused on margin over membership.

當然。所以您說得對，我們預計 2025 年的營運收入將略低於損益平衡點。我們的定價目標是在 2026 年恢復獲利。現在判斷該範圍究竟有多大還為時過早。但是，正如我所提到的，當我們考慮逐州重新提交和定價時，我們非常關注會員利潤。

We are being thoughtful about trying to bake in all of the assumptions that we see and now expect as we think about further morbidity shifts in 2026. And so being sort of prudent and conservative in our view and leaning on margin is what gives us a view of being able to deliver meaningful margin improvement.

當我們考慮 2026 年發病率的進一步變化時，我們正在認真考慮我們所看到和現在預期的所有假設。因此，我們認為採取謹慎和保守的態度並依靠利潤率使我們能夠實現有意義的利潤率提高。

The view of 2026 gets clearer as we get, one, through the rate filings; two, through the state certifications in August. And then in September -- towards the end of September, we get the first view of the equivalent of the landscape file, which is the (inaudible) file for Marketplace and understand where our pricing landed relative to peers. That will start to give us a better sense of what is possible for 2026.

隨著我們一通過費率備案，二通過八月份的國家認證，2026 年的前景將變得更加清晰。然後在九月 - 接近九月底，我們第一次看到了相當於景觀文件的內容，也就是市場（聽不清楚）文件，並了解我們的定價相對於同行而言處於什麼位置。這將使我們更了解 2026 年可能發生的情況。

And then I think moving through open enrollment and seeing how the impacts of the program integrity rules play out will obviously be sort of the key final factor. So as we get through that, we'll certainly give you updates on the view. But I think at this moment, it's too early to give any real solid ranges around Marketplace guidance for 2026, other than a return to profitability, which we think is pretty meaningful.

然後我認為，透過開放招生，看看計畫完整性規則的影響如何發揮作用，顯然是最終的關鍵因素。因此，當我們完成這項任務後，我們一定會向您提供最新觀點。但我認為，目前，除了恢復盈利能力（我們認為這非常有意義）之外，對 2026 年的市場指導給出任何真正的可靠範圍還為時過早。

John Stansel, JPMorgan.

摩根大通的約翰·斯坦塞爾。

Hey. Thanks for taking my question. I just wanted to drill down on the Part D update. Now I think you called out approximately $700 million of pretax favorability for the overall Medicare segment, with a portion of that attributable to Part D. It sounds like you're getting G&A leverage there. As you progress through the year, what are you seeing kind of around your assumptions that are giving kind of comfort?

嘿。感謝您回答我的問題。我只是想深入了解 D 部分的更新。現在我認為您為整個醫療保險部門爭取了大約 7 億美元的稅前優惠，其中一部分歸因於 D 部分。聽起來您在那裡獲得了 G&A 槓桿。隨著時間的流逝，您發現您的假設中哪些方面讓您感到安慰？

And then it sounds like you're well above the kind of the previous 1% margin target in that business. How are you thinking about that from a margin perspective? And with national bids coming out in the next week or so, any updated thoughts around what 2026 in Part D looks like with or without the demo? Thanks.

那麼聽起來你的利潤率已經遠高於之前該業務 1% 的利潤目標了。從利潤角度來說您如何看待這個問題？全國招標結果將在下週左右公佈，對於 D 部分的 2026 年（無論是否有演示）情況有什麼最新想法嗎？謝謝。

No. Good questions around PDP. And yeah, we, and we suspect others bid, assuming the demo does not continue, but we'll see what CMS decides to do. And so you're right, pleased with the performance in PDP. It's good to have now six months under our belt so we can see, coming into the year, the changes in the IRA, what that did to specialty trend.

不。關於 PDP 的好問題。是的，我們懷疑其他人也會競標，假設演示不會繼續，但我們會看看 CMS 決定做什麼。所以您說得對，我對 PDP 的表現很滿意。現在我們已經有六個月的經驗了，因此我們可以看到，進入新的一年，IRA 的變化對專業趨勢產生了什麼影響。

And you're right, we're north of our 1% budget margin. Of course, we bid for a higher margin than 1%. That's where we started our initial guidance at. So really pleased with what we're seeing. And it's a pretty stable membership in terms of Q1 to Q2. And with the IRA, you can anticipate a sloping upward in terms of the Medicare segment, HBR, which is highly influenced by PDP as we get through the year.

您說得對，我們的預算利潤率已經超過了 1%。當然，我們的出價利潤率高於1%。這就是我們開始進行初步指導的地方。我們對所看到的一切感到非常高興。從第一季到第二季來看，會員人數相當穩定。有了 IRA，你可以預見醫療保險部分 HBR 會呈上升趨勢，而這一部分在今年會受到 PDP 的極大影響。

Sarah James, Cantor.

莎拉詹姆斯，領唱者。

Thank you. Can you talk about how exchange progressed to the quarter? So was there a trend acceleration in claims or a noticeable market with pool deterioration in June compared to earlier in the quarter? And if so, are you assuming that it continues to accelerate throughout the end of the year?

謝謝。能談談本季的交流進度嗎？那麼，與本季稍早相比，6 月索賠的趨勢是否加速，或者市場池明顯惡化？如果是這樣，您是否認為它將在今年年底繼續加速？

Sarah, thanks for the questions. Just to clarify, you're asking about Marketplace, mix changes?

莎拉，謝謝你的提問。只是為了澄清一下，您問的是市場、混合變化嗎？

Yes.

是的。

Okay. Yeah, absolutely. Yes. So again, as we talked about, sort of the biggest factor for Marketplace was the morbidity shift, but we also saw broad utilization across categories. So that's inpatient, outpatient, [ER, PCP] And as we said earlier, that continued, the new member trend was more significant than renewing members.

好的。是的，絕對是如此。是的。因此，正如我們之前所討論的，Marketplace 的最大因素是發病率的轉變，但我們也看到了各個類別的廣泛利用。這就是住院病人、門診病人、[ER、PCP] 正如我們之前所說，新會員的趨勢比續約會員的趨勢更為顯著。

I think there have been a number of interesting hypotheses about what driving that. One that has been put forward is the idea that there are redetermined numbers for Medicaid that have moved into Marketplace and are driving that trend.

我認為關於背後的原因已經存在許多有趣的假設。有人提出的觀點是，重新確定的醫療補助數字已經進入市場並推動了這一趨勢。

What's interesting is, obviously, having the largest Medicaid and Marketplace book, we looked at that. And the volume of shifting members from our book to book in '24 and '25 was actually not different, I mean, almost exactly the same. What is interesting is that we are seeing higher utilization in the 2025 cohort, which does suggest that there is sort of a step-up in demand among the population.

有趣的是，顯然，我們擁有最大的醫療補助和市場書籍，我們對此進行了研究。而 1924 年和 1925 年從我們的書轉移到另一本書的會員數量實際上並沒有什麼不同，我的意思是，幾乎完全相同。有趣的是，我們看到 2025 年人口的使用率更高，這確實表明人口需求增加。

I'll sort of take a step back and just make an observation from a behavioral economics standpoint. If you think about Marketplace and Medicaid members, what these folks have been hearing from every major media outlet for the last six months is that Congress is going to take away their health insurance. And that I think does drive a certain level of behavior when compounded with macroeconomic uncertainty. We've seen this before in health care and health insurance.

我將退一步思考，從行為經濟學的角度來觀察。如果你考慮市場和醫療補助計劃的成員，你會發現這些人在過去六個月裡從各大媒體上聽到的消息是國會將取消他們的醫療保險。我認為，當宏觀經濟不確定性加劇時，這確實會推動一定程度的行為。我們以前在醫療保健和健康保險領域見過這種情況。

And then those folks are coming into the system and colliding with a provider ecosystem that is largely still operating in a fee-for-service manner is concerned about losing revenue. And that's where we're seeing, I think, some of the aggressive billing and coding. So all of that collides to that sort of third point I mentioned, which is a higher step-up in documented morbidity that is being connected to the utilization.

然後，這些人進入系統並與仍以收費服務方式運作的提供者生態系統發生衝突，擔心收入損失。我認為這就是我們所看到的一些激進的計費和編碼。所以所有這些都與我提到的第三點相衝突，即與利用率相關的記錄發病率的上升。

Now to your specific question, we didn't see any specific -- we're sort of seeing that level of utilization pretty consistent, and we are expecting and have baked in, which you heard in my remarks, trend in the back half of the year, consistent with that, as well as a potential step-up related to folks using the system in advance of a potential expiration of enhanced eAPTCs.

現在回答您的具體問題，我們沒有看到任何具體的情況 - 我們看到利用率水平相當一致，並且我們預計並且已經考慮到了這一點，正如您在我的發言中聽到的那樣，下半年的趨勢與此一致，以及在增強型 eAPTC 可能到期之前人們使用該系統的潛在提升。

Now what I think will be interesting to see is whether some of the pressure we've seen in the first half of the year actually represents essentially preemptive demand or a seasonal shift. And we've already accounted for some of that utilization in advance of the expiration of the subsidies, but we have accounted for it regardless just in an effort to be prudent as we think about the back half of the year.

現在，我認為有趣的是，看看我們在今年上半年看到的一些壓力是否實際上代表了先發制人的需求或季節性轉變。我們在補助到期之前就已經考慮到了部分利用率，但無論如何，我們還是將其考慮進去，只是為了在考慮下半年時保持謹慎。

Ann Hynes, Mizuho Securities.

瑞穗證券的安‧海因斯 (Ann Hynes)。

Hi, good morning. In your remarks, you talked about you see an increase in morbidity really driven by coding. Can you just talk about what states you're seeing that? And I think you said it's in a few states. What type of providers you're seeing increased coding? And I guess, going forward, how do you underwrite as an insurance company for coding changes? Because it is a behavior change that might be difficult to capture. Thanks.

嗨，早安。在您的評論中，您談到您看到發病率的增加實際上是由編碼引起的。您能談談您在哪些州看到了這種情況嗎？我認為您說過它存在於幾個州。您看到哪種類型的提供者增加了編碼？我想，展望未來，作為一家保險公司，您將如何承保編碼變更？因為這是一種可能難以捕捉的行為改變。謝謝。

Yeah. So again, I think the coding intensity, I don't think we have empirical data around. I think it's, again, somewhat speculative, but given what we're seeing, and we've got a number of other folks who've collaborated that. The recent weekly report that came out earlier this week spoke to that as well. It's really for us an extrapolation off of what we're seeing in terms of patterns.

是的。所以，我再說一遍，我認為我們沒有關於編碼強度的經驗數據。我認為這又有點推測，但根據我們所看到的情況，而且我們還有很多其他人也參與了這項工作。本週稍早發布的最新週報也談到了這一點。對我們來說，這實際上是根據我們所看到的模式進行的推論。

There are definitely very clear areas where we have seen a step-up in coding intensity, partly driven, I think, likely by revenue cycle activity at hospitals. And so there are very targeted areas that we are focused on there, and making sure that if they integrate AI into the revenue cycle, we're integrating AI into payment integrity to make sure that we are sort of keeping pace with all of that.

我們確實看到一些非常明顯的領域編碼強度有所提高，我認為部分原因可能是醫院的收入週期活動。因此，我們專注於一些非常有針對性的領域，並確保如果他們將人工智慧融入收入週期，我們也會將人工智慧融入支付完整性，以確保我們跟上所有這些步伐。

I do think that some of this idea of the coding intensity we're seeing, as I mentioned earlier, is a little bit of the behavioral economics byproduct, of folks seeking services because of scarcity and fear of loss, and then provider is concerned about revenue, and those two things colliding. So there aren't specific geographies where we would call out pressure points in markets. I think if you think about the larger hospital systems, that's probably where some of that sophistication is more likely to manifest.

我確實認為，正如我之前提到的，我們所看到的編碼強度這一概念有點像行為經濟學的副產品，人們因為稀缺性和害怕損失而尋求服務，而提供者則擔心收入，而這兩件事發生了衝突。因此，我們不會針對特定的地理位置指出市場的壓力點。我認為，如果你考慮大型醫院系統，那麼其中的一些複雜性可能更容易體現出來。

And knowing that, that's obviously part of our thoughtful investment as we go forward, to make sure that we are good stewards of taxpayer dollars. We're staying on top of opportunities for waste, fraud and abuse, and just being thoughtful about the fact that, as more members use services, we will higher documented morbidity as we catch the overall acuity and can adjust for that going forward.

並且知道這一點，這顯然是我們未來深思熟慮的投資的一部分，以確保我們能夠妥善管理納稅人的錢。我們始終密切關注浪費、欺詐和濫用的機會，並且深思熟慮的是，隨著越來越多的會員使用服務，我們將掌握整體敏銳度，並在未來進行調整，從而提高記錄的發病率。

So I think some of this, in some ways, in Marketplace, what we're seeing is a little bit of a version of redeterminations, and getting a clearer picture -- redeterminations for the Marketplace, right? So similar to what we saw in Medicaid. And getting a clearer picture of what the baseline morbidity of that population is. So not really concerned that coding intensity is sort of going to get away from us. I think that's pretty normal course, and we're paying attention to where we need to get out ahead of that.

所以我認為，從某種程度上來說，我們在市場上看到的是某種形式的重新確定，並且能夠更清晰地了解市場重新確定的情況，對嗎？與我們在醫療補助計劃中看到的情況非常相似。並更清楚地了解該族群的基線發生率。因此我們並不真正擔心編碼強度會超出我們的承受範圍。我認為這是很正常的事情，我們正在關注我們需要如何取得進展。

Michael Ha, Baird.

麥可·哈，貝爾德。

Thank you. Just quickly first on exchanges in the back half guide. I know you mentioned assumptions on induced utilization, FTR [shifts] morbidity shifts. But was there anything included on CMS has identified duplicative members, how that could impact the risk pool? And are there any other meaningful buckets worth calling out?

謝謝。首先快速介紹後半部的交流指南。我知道您提到了關於誘導利用、FTR [轉變] 發病率轉變的假設。但是 CMS 中是否包含已識別重複成員的內容，這會對風險池產生什麼影響？還有其他值得一提的有意義的桶子嗎？

And then apologies in advance for this longer question. Just following up on Kevin's question. Try to understand, despite the shift in the landscape, you still believe the staying power of Medicaid is as strong as ever. But as we look to '27 work requirements, I understand the actual percentage of Medicaid lives where able-bodied expansion adults is rather small, but just based on our channel checks and in talking enrollment analytics professionals this year, seems to be more on the negative precedent that the redetermination set on procedural disenrollment, if members who shouldn't even qualify end up being required to submit any type of paperwork, they failed to do so, you see outsized procedure of disenrollment, that drives further margin pressure in the next few years.

然後提前為這個較長的問題道歉。只是繼續回答凱文的問題。試著去理解，儘管情況發生了變化，但您仍然相信醫療補助的持久力一如既往地強大。但是，當我們看 27 個工作要求時，我了解到，在醫療補助計劃中，健全成年人的實際比例相當小，但僅根據我們今年的渠道檢查和與註冊分析專家的交談，似乎更多的是重新確定程序取消註冊所設定的負面先例，如果原本不符合資格的成員最終被要求提交任何類型的文書工作，而他們卻沒有進一步取消利潤，那麼這進一步註冊的風險。

But when you think about that and the learnings from your recent redeterminations and what Centene can apply on your own end to help avoid that? Just wondering what are those tactics or best practices that you can implement? Thank you.

但是，當您考慮到這一點以及您最近的重新確定所獲得的經驗教訓以及 Centene 可以在您自己方面應用什麼來幫助避免這種情況時？只是想知道您可以實施哪些策略或最佳實踐？謝謝。

Great questions. Okay. Let me make sure I hit all of these. So first, back half of the year for Marketplace, additional pools where we may see member attrition. You called out duplicative members. We track that pretty closely. We don't anticipate sort of a huge shift from that. But we're obviously paying attention to it, and that's part of accounting. The provision that we put in the back half of the year accounts for additional morbidity shifts and utilization.

很好的問題。好的。讓我確保我達到了所有這些目標。首先，對於 Marketplace 來說，今年下半年，我們可能會看到會員流失的現象。您呼喚了重複的成員。我們對此進行了密切追蹤。我們預計不會出現巨大的轉變。但我們顯然正在關注這一點，這是會計的一部分。我們在下半年制定的規定考慮了額外的發病率變化和利用率。

FTR, I mentioned, that's another pool that folks should be paying attention to because that shifted to summer. We're now seeing that come in -- we believe we're seeing the first wave of that in August. So that's part of what drives our 5.9 million to 5.4 million. So in that bucket is the idea that there will be additional attrition and then some degree of morbidity shift in the back half of the year.

FTR，我提到過，這是另一個人們應該關注的游泳池，因為它已經轉移到夏天了。我們現在看到了這種情況的出現——我們相信我們將在八月看到第一波這種情況。這也是我們的銷售量從 590 萬增加到 540 萬的原因之一。因此，我們的想法是，今年下半年將會出現進一步的人員流失，然後發病率將出現一定程度的轉變。

So shifting to Medicaid and looking out longer term. So one, we've commented on sort of the staying power of Medicaid. I do want to make just one comment and then I'll get very specifically into your question about how we can optimize coverage for members in light of work requirements and other sort of eligibility verifications.

因此轉向醫療補助並著眼於更長遠的未來。首先，我們對醫療補助的持久力進行了評論。我確實想發表一條評論，然後我會非常具體地回答你的問題，即我們如何根據工作要求和其他資格驗證來優化會員的覆蓋範圍。

When you think about One Big Beautiful Bill, there's a lot of conversation about how those provisions have landed and what the negative impact may be. I think it's really important to also remember that there were a number of far more disruptive provisions that were discussed and could have been introduced in that. So things like per capita caps, FMAP reduction, block grants, all of which really got taken off the table very early in the conversation. And the reason I point that out is just because what that should tell you is that Medicaid has more bipartisan support than it has ever had as a program. So that's really sort of the core of our view of the staying power in Medicaid.

當你想到「一項美麗的大法案」時，你會有很多關於這些條款如何實施以及可能產生哪些負面影響的討論。我認為同樣重要的是要記住，其中討論過許多更具破壞性的條款，而且這些條款本來可以引入的。因此，諸如人均上限、FMAP 削減、整筆撥款等問題在討論的初期就被擱置了。我指出這一點的原因只是因為這應該告訴你，醫療補助計劃比以往任何時候都獲得了兩黨的支持。所以這其實是我們對醫療補助持久力的看法的核心。

And then to your point, one of the benefits, and I think one of the things that's going to be super important as we go forward, even more important than the past, is size and scale. And that is -- we're going to need to operate at a different level of efficiencies, and we're going to need to be able to lean in to think about how to reduce the friction of things like six-month verifications and things like work requirements to maximize coverage where it's appropriate.

然後回到你的觀點，其中一個好處，我認為隨著我們前進，其中一件比過去更重要的事情就是規模和範圍。那就是——我們需要以不同的效率水平運作，我們需要能夠傾向於思考如何減少諸如六個月驗證和工作要求之類的摩擦，以在適當的情況下最大限度地擴大覆蓋範圍。

So again, we have the benefit of a couple of years here relative to implementation. Worth noting that we'll have to see what happens in midterms and what that may or may not do to time frames and sort of how these provisions unfold. But we are actively working on strategies to move to more digital enrollment and reenrollment as well as work requirement verification, which is something that CMS and administration leadership are very passionate about. So really aligned in that and being thoughtful about innovative partners that could help with that.

因此，我們在實施上又獲得了幾年的優勢。值得注意的是，我們必須觀察中期選舉會發生什麼，以及這可能會或可能不會對時間框架和這些條款的實施產生什麼影響。但我們正在積極制定策略，以實現更多的數位化註冊和重新註冊以及工作要求驗證，這是 CMS 和行政領導層非常熱衷的事情。因此，我們真正與此保持一致，並認真考慮可以提供幫助的創新合作夥伴。

We have a number -- we have a history because we have states that have work requirements, of actually helping members get work and work programs. And so ramping those up and thinking about how we can make sure that folks who are doing good work or are going to school or are serving as caretakers are really correctly documented as such.

我們有一個數字——我們有歷史，因為我們有各州的工作要求，實際上幫助成員獲得工作和工作計劃。因此，我們要加強這些工作，思考如何確保那些工作出色、上學或擔任照顧者的人得到正確的記錄。

And then the last thing I will point out, which is a very small win that went by, but nobody is really talking about, but we talked about it a lot during redeterminations was the idea that, because of TCPA historically had a harder time reaching out to members digitally. But one of the things that's very deep in OB3 is actually a change to that, which I think opens the opportunity for a different level of digital interaction with Medicaid members. And that's something that we need to push hard on to make sure that both the verification process and the work requirement documentation process take advantage of that.

然後我要指出的最後一件事是，這是一個非常小的勝利，但沒有人真正談論它，但我們在重新確定期間多次討論過這個問題，因為 TCPA 歷史上很難透過數位方式聯繫到會員。但 OB3 的一個非常深層的功能實際上是對此進行了改變，我認為這為與醫療補助成員進行不同層次的數位互動創造了機會。我們需要大力推動這一點，以確保驗證過程和工作要求文件過程都能利用這一點。

And I think that will help, again, make sure that, where members are eligible, they get coverage, and then continue to work state by state to ensure that as the states view of what able-bodied is and the degree to which they want coverage for those populations, we are good partners and ultimately maximize the coverage for vulnerable Americans.

我認為這將有助於再次確保符合條件的成員能夠獲得保障，然後繼續逐個州開展工作，以確保各州對健全人的定義以及他們希望為這些人群提供保障的程度有所了解，我們是良好的合作夥伴，並最終最大限度地為弱勢美國人提供保障。

Thank you. This concludes our question-and-answer session. I'd like to turn the conference back over to Sarah London for closing remarks.

謝謝。我們的問答環節到此結束。我想將會議交還給莎拉倫敦 (Sarah London) 做閉幕發言。

Thanks, Rocco, and thanks, everyone, as always, for your thoughtful questions and your interest in Centene. We look forward to providing updates as we have additional visibility in some of these key milestones that we've talked about this morning over the next few months.

謝謝，羅科，也一如既往地感謝大家提出的深思熟慮的問題以及對 Centene 的興趣。我們期待在接下來的幾個月提供更新，因為我們對今天上午討論的一些關鍵里程碑有了更多的了解。

I do want to end today by addressing the many members of the CenTeam who I know are listening this morning. Over the last three years, you all have done tremendous work to transform this organization. And these results do not reflect this progress nor what you do every day to ensure that our members get the care and the support that they need to lead healthy lives.

今天，我確實想透過向今天早上正在聆聽的 CenTeam 的許多成員發表演講來結束今天的演講。在過去三年裡，你們為改變這個組織做出了巨大的努力。這些結果並不能反映出這種進步，也不能反映出你們每天所做的努力，以確保我們的會員得到他們過上健康生活所需的照顧和支持。

We are operating in unprecedented times, and we have hard work ahead of us. But I have total confidence in this team's ability to tackle those challenges and to deliver meaningful results. We are on a mission to transform the health of the communities we serve one person at a time, and there is no team I would rather be on this mission with. Thank you all.

我們正處於前所未有的時期，我們面臨著艱鉅的工作。但我完全相信這個團隊有能力應對這些挑戰並取得有意義的成果。我們的使命是改善我們所服務社區中每個人的健康狀況，沒有一個團隊比我們更願意與他一起完成這項使命。謝謝大家。

Thank you. This concludes today's conference call. We thank you all for attending today's presentation. You may now disconnect your lines and have a wonderful day.

謝謝。今天的電話會議到此結束。感謝大家參加今天的演講。現在您可以斷開線路並享受美好的一天。