Oscar Health Inc (OSCR) 2025 Q2 法說會逐字稿

Good morning. My name is Kelvin, and I will be your conference operator today. At this time, I would like to welcome everyone to the Oscar Health second-quarter 2025 earnings conference call. (Operator Instructions)

早安.我叫凱爾文，今天我將擔任您的會議主持人。現在，我歡迎大家參加 Oscar Health 2025 年第二季財報電話會議。（操作員指示）

I will now turn the conference over to Chris Potochar, Vice President of Treasury and Investor Relations. Please go ahead.

現在我將會議交給財務與投資人關係副總裁克里斯‧波托查爾 (Chris Potochar)。請繼續。

Good morning, everyone. Thank you for joining us for our second-quarter 2025 earnings call. Mark Bertolini, Oscar Health's Chief Executive Officer; and Scott Blackley, Oscar's Chief Financial Officer, will host this morning's call. This call can also be accessed through our Investor Relations website at ir.hioscar.com. Full details of our results and additional management commentary are available in our earnings release, which can be found on our Investor Relations website at ir.hioscar.com.

大家早安。感謝您參加我們的 2025 年第二季財報電話會議。Oscar Health 執行長 Mark Bertolini 和 Oscar 財務長 Scott Blackley 將主持今天上午的電話會議。您也可以透過我們的投資者關係網站 ir.hioscar.com 存取本次電話會議。有關我們業績的完整詳情及其他管理層評論，請參閱我們的收益報告，該報告可在我們投資者關係網站 ir.hioscar.com 上找到。

Any remarks that Oscar makes about the future constitute forward-looking statements within the meaning of safe harbor provisions under the Private Securities Litigation Reform Act of 1995. 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 annual report on Form 10-K for the period ended December 31, 2024, and the quarterly report on Form 10-Q for the period ended March 31, 2025, each as filed with the SEC, and other filings with the SEC, including our quarterly report on Form 10-Q for the quarterly period ended June 30, 2025, to be filed with the SEC.

Oscar 對未來所做的任何評論均構成 1995 年《私人證券訴訟改革法案》安全港條款所定義的前瞻性陳述。由於各種重要因素，實際結果可能與前瞻性陳述所示的結果有重大差異，包括我們向美國證券交易委員會提交的截至 2024 年 12 月 31 日的 10-K 表年度報告和截至 2025 年 3 月 31 日的 10-Q 表季度報告中討論的因素，以及向美國證券交易委員會提交的其他文件，包括我們將截至 205 月的證券交易委員會提交的10-Q 表格季度報告。

Such forward-looking statements are based on current expectations as of today. Oscar anticipates that subsequent events and developments may cause 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 to the most directly comparable GAAP measures can be found in the second-quarter earnings press release available on the company's Investor Relations website at ir.hioscar.com.

此類前瞻性陳述是基於截至今天的當前預期。奧斯卡預計後續事件和發展可能會導致估計發生變化。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。這些指標與最直接可比較的 GAAP 指標的對帳可以在公司投資者關係網站 ir.hioscar.com 上的第二季財報新聞稿中找到。

We have not provided a quantitative reconciliation of estimated full year 2025 adjusted EBITDA as described on this call to GAAP net income because Oscar is unable, without making unreasonable efforts to calculate certain reconciling items with confidence.

我們沒有提供本次電話會議中所述的 2025 年全年預計調整後 EBITDA 與 GAAP 淨收入的定量對賬，因為 Oscar 無法在不付出不合理努力的情況下自信地計算某些對賬項目。

With that, I would like to turn the call over to our CEO, Mark Bertolini.

說完這些，我想把電話轉給我們的執行長馬克貝爾托里尼 (Mark Bertolini)。

Good morning. Thank you, Chris, and thank you all for joining us. Today, Oscar announced second quarter results, which are consistent with the preliminary results we released on July 22. We reported total revenue of $2.9 billion, a 29% increase year over year. MLR increased 12 points year over year to 91.1%, primarily driven by an overall increase in average market morbidity.

早安.謝謝你，克里斯，也謝謝大家加入我們。今天，Oscar公佈了第二季業績，與我們7月22日發布的初步結果一致。我們報告的總收入為 29 億美元，年增 29%。MLR 年增 12 個百分點，達到 91.1%，主要得益於市場平均發病率的整體上升。

Conversely, our SG&A ratio of 18.7% improved 90 basis points year over year. Overall, Oscar reported a loss from operations of $230 million, and the adjusted EBITDA loss was $199 million.

相反，我們的銷售、一般及行政費用比率為 18.7%，年比提高了 90 個基點。總體而言，Oscar 報告的營業虧損為 2.3 億美元，調整後的 EBITDA 虧損為 1.99 億美元。

In the first half of the year, earnings from operations were $66 million and adjusted EBITDA was $129 million. We are also reaffirming our updated 2025 guidance, including revenue of $12 billion to $12.2 billion and a loss from operations of $200 million to $300 million. Scott will walk through our financial updates in greater detail in a few moments.

上半年，營業利潤為 6,600 萬美元，調整後 EBITDA 為 1.29 億美元。我們也重申了更新後 2025 年的指引，包括 120 億至 122 億美元的收入和 2 億至 3 億美元的營業虧損。斯科特稍後將更詳細地介紹我們的財務更新。

Now I want to share our view of what we are seeing in the individual market and why we believe the market will stabilize in 2026. We continue to believe in the long-term importance of the individual market for millions of consumers and employers.

現在我想分享我們對個人市場的看法，以及我們為什麼相信市場將在 2026 年穩定下來。我們始終相信個人市場對數百萬消費者和雇主具有長期重要性。

Let's start with recent market dynamics. The latest risk adjustment data from Wakeley, which includes claims data through April 30, indicates a meaningful market-wide increase in morbidity in 2025. This morbidity shift is impacting all carriers, increasing by mid- to high-single digits across Oscar's markets. We attribute market morbidity increases to consumers entering the individual market for Medicaid redeterminations and healthier, low-utilizing consumers leaving the market in part due to program integrity efforts.

讓我們從最近的市場動態開始。Wakeley 的最新風險調整數據（包括截至 4 月 30 日的索賠數據）表明，2025 年整個市場的發病率將大幅上升。這種發病率變化正在影響所有營運商，Oscar 市場中的發病率以中高個位數成長。我們將市場發病率的上升歸因於消費者進入個人市場進行醫療補助重新確定，以及更健康、利用率較低的消費者離開市場（部分原因是由於計劃完整性努力）。

Oscar is taking several actions to drive value and mitigate the impact of current industry-wide headwinds. We resubmitted 2026 rate filings in states covering nearly all current membership to reflect morbidity increases. Our engagement with state regulators continues to be productive. Our initial rate filings already reflected program integrity changes and the expiration of enhanced premium tax credits.

Oscar 正在採取多項措施來推動價值並減輕當前整個行業不利因素的影響。我們向幾乎涵蓋所有現有會員的州重新提交了 2026 年的費率申報表，以反映發病率的上升。我們與國家監管機構的合作持續富有成效。我們的初始費率申報已經反映了計劃完整性的變化和增強保費稅收抵免的到期。

We expect the market will have double-digit rate increases next year. We believe these overall rate increases will address the current morbidity pressure and the effects of program integrity efforts for 2026. We also see potential upside with growing support to renew enhanced premium tax credits in the upcoming continuing resolution.

我們預計明年市場利率將出現兩位數的成長。我們相信，這些整體費率的提高將解決當前的發病率壓力和 2026 年專案完整性努力的影響。我們還看到，在即將出台的持續決議中，越來越多的人支持更新增強保費稅收抵免，從而帶來潛在的好處。

Oscar is a leader in the individual market with a 12-year track record of navigating dynamic markets. We are focused on what we can control. In addition to repricing, we remain disciplined in our expense management. Our team is rightsizing the cost of the business in the back half of this year.

Oscar 是個人市場領域的領導者，擁有 12 年駕馭動態市場的豐富經驗。我們專注於我們能夠控制的事情。除了重新定價之外，我們在費用管理方面也保持嚴格。我們的團隊正在調整今年下半年的業務成本。

We continue to harvest technology and AI-driven efficiencies to optimize our operations and drive several medical cost affordability initiatives. The team is also reducing fixed cost headcount. We expect these actions will eliminate approximately $60 million in administrative costs for 2026. We also improved our 2025 SG&A guidance by 50 basis points at the midpoint compared to initial guidance.

我們繼續利用技術和人工智慧驅動的效率來優化我們的營運並推動多項醫療成本可負擔性措施。該團隊還在減少固定成本員工數量。我們預計這些措施將在 2026 年消除約 6,000 萬美元的管理成本。與初步指引相比，我們也將 2025 年銷售、一般及行政費用指引中位數提高了 50 個基點。

The individual market is experiencing a reset moment, but the market is resilient, and we see significant opportunity for long-term growth. The individual markets' fundamental characteristics, combined with ICHRA will drive a growing and stable risk pool over the long term. Oscar is at the center of building this future and is creating a competitive health care market for many more consumers and businesses.

個人市場正在經歷重置時刻，但市場具有彈性，我們看到了長期成長的巨大機會。各個市場的基本特徵與 ICHRA 相結合，將推動長期不斷成長且穩定的風險池。奧斯卡是建立這個未來的核心，正在為更多的消費者和企業創造一個有競爭力的醫療保健市場。

We are announcing several strategic steps to power ICHRA and further diversify our business. We acquired important early-stage assets with capabilities to help us build the consumer marketplace of the future. These assets include an individual market brokerage, a direct enrollment technology platform, and a consumer education website, healthinsurance.org.

我們宣布了幾項策略措施來增強 ICHRA 的實力並進一步實現業務多元化。我們收購了重要的早期資產，這些資產有能力幫助我們建立未來的消費者市場。這些資產包括個人市場經紀、直接註冊技術平台和消費者教育網站 healthinsurance.org。

We are also launching a new ICHRA product with a well-known consumer brand in the Midwest, Hy-Vee, Inc. Our new ICHRA assets will give us capabilities to meet and exceed the expectations of consumers and employers. The technology platform, INSXCloud, is a fundamental asset of the marketplace as it is one of only 11 CMS-approved solutions, creating a digital storefront for all health products.

我們也將與中西部知名消費品牌 Hy-Vee, Inc. 合作推出一款新的 ICHRA 產品。我們的新 ICHRA 資產將使我們能夠滿足並超越消費者和雇主的期望。該技術平台 INSXCloud 是市場的基本資產，因為它是僅有的 11 個 CMS 批准的解決方案之一，為所有健康產品創建了一個數位店面。

The brokerage, IHC Specialty Benefits offers individual medical and supplemental health products across carriers in all 50 states. The brokerage will allow us to offer consumers the supplemental health products they typically buy with health insurance. While the acquisition will not have a meaningful impact on our near-term results, we believe these capabilities are important building blocks of our long-term strategy.

經紀公司 IHC Specialty Benefits 為全美 50 個州的保險公司提供個人醫療和補充健康產品。透過經紀業務，我們可以向消費者提供他們通常透過健康保險購買的補充健康產品。雖然此次收購不會對我們的短期業績產生重大影響，但我們相信這些能力是我們長期策略的重要組成部分。

Hy-Vee is one of the most trusted brands in the nation with 570 grocery and convenience stores and 270 retail pharmacies. Hy-Vee and Oscar are introducing a new Hy-Vee health branded ICHRA plan. We are initially launching this product for employers and employees in Des Moines, Iowa for plan year 2026, subject to state approval.

Hy-Vee 是全國最值得信賴的品牌之一，擁有 570 家雜貨店和便利商店以及 270 家零售藥局。Hy-Vee 和 Oscar 正在推出一項新的 Hy-Vee 健康品牌 ICHRA 計劃。我們將首先在 2026 計畫年度向愛荷華州得梅因市的雇主和員工推出該產品，但需獲得州政府的批准。

The plan offers superior benefits, including concierge medicine at an affordable fixed price through Hy-Vee Health Exemplar Care clinics. Our partnership is an example of the innovation we intend to drive with other employers, provider systems and consumer brands in the United States.

該計劃提供優質福利，包括透過 Hy-Vee Health Exemplar Care 診所以可負擔的固定價格提供禮賓醫療服務。我們的合作關係是我們打算與美國其他雇主、供應商系統和消費品牌共同推動的創新的一個例子。

In summary, Oscar is well positioned to manage through the market reset in 2025. We believe the market will stabilize next year, and we expect to return to profitability in 2026. Oscar's track record of disciplined execution, strong management processes and a highly skilled team will continue moving us toward long-term growth.

總而言之，Oscar 已準備好應對 2025 年的市場重置。我們相信明年市場將會穩定，並預計2026年將恢復獲利。Oscar 嚴謹的執行力、強大的管理流程和高技能團隊的記錄將繼續推動我們實現長期成長。

The individual market has greater long-term upside and is the future of health care. It is a market powered by individual choice. Choice drives a competitive market where consumers direct the innovation they want. Every American and American business deserves high-quality, affordable healthcare that fits their needs.

個人市場有更大的長期上漲空間，是醫療保健的未來。這是一個由個人選擇驅動的市場。選擇推動競爭性的市場，消費者可以主導他們想要的創新。每個美國人和美國企業都應該享有符合其需求的高品質、負擔得起的醫療保健。

I want to thank the Oscar team for their leadership and hard work. We continue to execute against our strategy, stay responsive to the consumer and harness AI to move faster than the market. We are a company built on great technology with an exceptional member experience that will change healthcare.

我要感謝奧斯卡團隊的領導和辛勤工作。我們將繼續執行我們的策略，對消費者保持回應，並利用人工智慧比市場更快發展。我們是一家以先進技術為基礎的公司，擁有卓越的會員體驗，將改變醫療保健產業。

Now, I will turn the call over to Scott to discuss our financials in more detail. Scott?

現在，我將把電話轉給史考特，讓他更詳細地討論我們的財務狀況。史考特？

Thank you, Mark, and good morning, everyone. This morning, we reported our second quarter financial results and reaffirmed the updated outlook we provided a couple of weeks ago. There is a market-wide shift occurring in the ACA marketplace, shifting towards higher average market morbidity. While we are now projecting a loss for 2025, we are taking corrective actions to ensure we are well positioned to return to profitability next year.

謝謝你，馬克，大家早安。今天上午，我們報告了第二季的財務業績，並重申了幾週前提供的最新展望。ACA 市場正在發生全面轉變，轉向更高的平均市場發病率。雖然我們目前預計 2025 年將出現虧損，但我們正在採取糾正措施，以確保我們能夠在明年恢復獲利。

In the second quarter, total revenues increased 29% year over year to $2.9 billion, driven by higher membership. We ended the quarter with more than 2 million members, an increase of 28% year over year. Membership growth was driven by solid retention, above-market growth during open enrollment and continuing SEP member additions.

第二季度，由於會員人數增加，總收入年增 29%，達到 29 億美元。截至本季末，我們的會員數已超過 200 萬，年增 28%。會員人數的成長得益於穩定的保留率、開放註冊期間高於市場的成長以及持續的 SEP 會員增加。

The second quarter medical loss ratio was 91.1%, an increase of 12 points year over year. The second quarter MLR was impacted by an incremental $316 million increase to our risk adjustment payable for 2025, driven by higher ACA marketplace morbidity that increased by more than our prior estimates. We recognized the year-to-date impact of the risk adjustment change in the second quarter. Applying the revised risk transfer accrual consistently across the first half would have resulted in an MLR of 80.7% in the first quarter and 85.1% MLR in the second quarter.

第二季醫療損失率為91.1%，較去年同期上升12個百分點。第二季 MLR 受到 2025 年風險調整應付款項增量 3.16 億美元的影響，這是由於 ACA 市場發病率上升，增幅超過我們先前的估計。我們承認第二季風險調整變化對年初至今的影響。如果在上半年持續應用修訂後的風險轉移應計率，第一季的 MLR 將達到 80.7%，第二季的 MLR 將達到 85.1%。

With regard to the final CMS risk report for 2024, it was approximately $23 million favorable to the accruals as of the first quarter of 2025.

就 2024 年的最終 CMS 風險報告而言，截至 2025 年第一季度，它對應計專案有利約 2,300 萬美元。

Turning now to utilization. Second quarter utilization moderated meaningfully as compared to the first quarter. We saw sequential softening in utilization each month in the second quarter. Inpatient utilization remained elevated compared to our expectations and was partially offset by continued favorability in pharmacy. Outpatient and professional were largely in line with our expectations.

現在轉向利用。與第一季相比，第二季的利用率明顯下降。我們發現第二季每個月的使用率都在連續下降。與我們的預期相比，住院利用率仍然較高，但被藥局的持續青睞所部分抵消。門診和專業基本上符合我們的預期。

Switching to administrative costs. We continue to deliver improvement in the SG&A expense ratio. The second quarter SG&A expense ratio improved 90 basis points year over year to 18.7%. The year over year improvement was driven by lower exchange fee rates and fixed cost leverage, partially offset by the impact of a higher risk adjustment payable as a percentage of premium.

轉向管理費用。我們持續改善銷售、一般及行政費用率。第二季銷售、一般及行政費用率較去年同期改善 90 個基點至 18.7%。年比改善的推動力是較低的匯率和固定成本槓桿，但部分被保費百分比計算的較高風險調整的影響所抵消。

In the second quarter, the loss from operations was $230 million, a decrease of $298 million year over year, and the net loss was $228 million, a $285 million decrease year over year.

第二季度，營業虧損為2.3億美元，年減2.98億美元；淨虧損2.28億美元，年減2.85億美元。

The adjusted EBITDA loss was $199 million in the quarter, a decrease of $304 million year over year.

本季調整後的 EBITDA 虧損為 1.99 億美元，年減 3.04 億美元。

Shifting to the balance sheet. Our capital position remains very strong. We ended the second quarter with approximately $5.4 billion of cash and investments, including $205 million of cash and investments at the parent. As of June 30, 2025, our insurance subsidiaries had approximately $1.2 billion of capital and surplus, including $579 million of excess capital.

轉向資產負債表。我們的資本狀況依然非常強勁。截至第二季末，我們擁有約 54 億美元的現金和投資，其中包括母公司 2.05 億美元的現金和投資。截至 2025 年 6 月 30 日，我們的保險子公司擁有約 12 億美元的資本和盈餘，其中包括 5.79 億美元的超額資本。

Let me spend a moment on uses of cash. We expect the majority of the expected losses this year to be absorbed by the significant excess capital position of our insurance subsidiaries. With respect to quota share reinsurance, we expect our ceding percentage to be just under 50% for 2025.

讓我花一點時間討論現金的用途。我們預計今年的大部分預期損失將被我們保險子公司的大量超額資本部位吸收。對於份額再保險，我們預期 2025 年的分保比例將略低於 50%。

Turning now to 2025 full year guidance. We are reaffirming the updated outlook we shared with the preliminary second quarter results. We expect total revenues in the range of $12 billion to $12.2 billion in 2025, an increase of $850 million at the midpoint compared to the prior guidance range.

現在談談 2025 年全年指引。我們重申了我們在第二季初步業績中分享的最新展望。我們預計 2025 年總收入將在 120 億美元至 122 億美元之間，與先前的指導範圍相比，中位數增加 8.5 億美元。

Our improved outlook is driven by better-than-expected retention and higher SEP member additions. We expect SEP member additions to moderate in the back half of the year, as continuous monthly SEP for those at or below 150% of the federal poverty level ends September 1. The revised guidance assumes risk adjustment as a percentage of direct and assumed policy premiums is in the mid-teens range and largely consistent year over year.

我們改善的前景是由於保留率好於預期以及 SEP 成員數量的增加。我們預計，今年下半年 SEP 成員的增加將會放緩，因為對於收入處於或低於聯邦貧困線 150% 的人而言，連續每月的 SEP 將於 9 月 1 日結束。修訂後的指南假設風險調整佔直接和假設保單保費的百分比處於十幾歲左右，並且與去年同期基本保持一致。

Shifting to the medical loss ratio. We expect a full year MLR in the range of 86% to 87% with the increase driven by higher average market morbidity. The revised outlook contemplates higher market morbidity, the continuation of our first half utilization patterns with a modest increase in utilization in the fourth quarter as members may seek additional care if the enhanced premium tax credits are not extended.

轉向醫療損失率。我們預計全年 MLR 將在 86% 至 87% 之間，成長是由更高的平均市場發病率推動的。修訂後的展望考慮到了更高的市場發病率，我們上半年的利用率模式將持續，第四季度的利用率將略有增加，因為如果增強的保費稅收抵免不延長，會員可能會尋求額外的護理。

On administrative expenses, we expect a slightly better SG&A expense ratio in the range of 17.1% to 17.6%, driven by greater operating leverage and variable cost efficiencies.

在管理費用方面，我們預期銷售、一般及行政費用率將略有改善，介於 17.1% 至 17.6% 之間，這得益於更高的經營槓桿和變動成本效率。

We expect a loss from operations in the range of $200 million to $300 million and an adjusted EBITDA loss of approximately $120 million less than the loss from operations. As Mark mentioned, we are reducing our workforce in the back half of 2025 with run rate savings starting in 2026.

我們預計營業虧損在 2 億至 3 億美元之間，調整後的 EBITDA 虧損比營業虧損少約 1.2 億美元。正如馬克所提到的，我們將在 2025 年下半年減少員工數量，並從 2026 年開始節省營運成本。

In closing, we are taking appropriate actions to return to profitability in 2026. Our 2026 rate filings reflect the higher market morbidity in addition to having contemplated trend, impacts from program integrity efforts and the expiration of the enhanced premium tax credits.

最後，我們正在採取適當措施，爭取在 2026 年恢復獲利。我們的 2026 年費率申報反映了更高的市場發病率，此外還考慮了趨勢、計劃完整性努力的影響以及增強保費稅收抵免的到期。

We know how to successfully navigate dynamic markets. We will continue to execute against our strategic plan, and we expect to deliver meaningful improved financial performance next year.

我們知道如何成功駕馭動態市場。我們將繼續執行我們的策略計劃，並期望明年的財務表現能顯著改善。

With that, I will turn the call over to the operator for the Q&A portion of our call.

說完這些，我將把電話轉給接線生，進行電話的問答部分。

(Operator Instructions) Josh Raskin, Nephron Research.

（操作員指示）Josh Raskin，Nephron Research。

Hi, thanks. Appreciate the comments, Scott, on the uses of cash. But can you provide some guidance on 2025 free cash flow, understanding the strength in the first half, and then the outflows, I assume, in the second half?

你好，謝謝。斯科特，感謝您對現金用途的評論。但是，您能否對 2025 年自由現金流提供一些指導，了解上半年的實力，然後我假設下半年的流出情況？

And then on the risk adjustment payable, I know there's a lot of moving parts there, but I think the total on the balance sheet is about $2.65 billion. I think 2024 balance was $1.65 billion. It sounds like there was a small change there, so maybe there's something around $1 billion for 2025. And then, I guess my question would be, why would the payable as a percentage of revenues be lower in '25 relative to '24?

然後關於風險調整應付款項，我知道其中有很多變動部分，但我認為資產負債表上的總額約為 26.5 億美元。我認為 2024 年的餘額是 16.5 億美元。聽起來那裡有一個小的變化，所以到 2025 年可能在 10 億美元左右。然後，我想我的問題是，為什麼 25 年應付款項佔收入的百分比相對於 24 年會較低？

Yeah. Well, Josh, let me start with your question about cash. So as we talked about in the prepared remarks, we feel like we've got a very strong capital position at this point, $5.4 billion of total cash and investments, $579 million in excess capital and $205 million of cash at the parent. The vast majority of the cash and investments are in our insurance subsidiaries, which more than covers the risk adjustment payable as well as our required capital, and that's where you end up with the excess capital. We think that the bulk of the remaining losses that we're forecasting for this year are going to be absorbed by that excess capital position.

是的。好吧，喬希，讓我先從你關於現金的問題開始。因此，正如我們在準備好的評論中所討論的那樣，我們覺得我們目前的資本狀況非常強勁，總現金和投資為 54 億美元，超額資本為 5.79 億美元，母公司現金為 2.05 億美元。絕大多數現金和投資都在我們的保險子公司中，這些資金足以支付風險調整應付款項以及我們所需的資本，而這些資金最終都會流向剩餘資本。我們認為，我們預測的今年剩餘損失的大部分將被過剩資本部位吸收。

And so you saw that our excess capital decreased by about $300 million from last quarter. And that was the subsidiaries absorbing the losses in the second quarter. And with respect to parent cash then, I do think that parent cash will decline in the back half of the year, largely due to us making some additional capital contribution to the insurance subsidiaries where we don't have as much excess capital. But we feel confident that parent cash is going to be at levels that remain more than sufficient to cover the cost of the holding company and the things that we need.

因此，您會看到我們的超額資本比上一季減少了約 3 億美元。那就是子公司在第二季所承擔的損失。至於母公司現金，我確實認為母公司現金將在下半年下降，主要是因為我們向沒有那麼多過剩資本的保險子公司進行了額外的資本投資。但我們相信，母公司的現金水準將足以支付控股公司的成本和我們所需的東西。

So we feel really good about where our capital position was going into this change in market morbidity and are confident that we've got the access to funding that we need to continue to run this company.

因此，我們對我們的資本狀況在市場狀況變化中所處位置感到非常滿意，並且有信心我們能夠獲得繼續經營這家公司所需的資金。

Okay. Okay. That's perfect. And then just if could follow-up, how should we be thinking about your previous long-term targets for 2027, specifically the 5% margin and the $2.25 of EPS?

好的。好的。那很完美。然後如果可以跟進的話，我們應該如何看待您先前設定的 2027 年長期目標，特別是 5% 的利潤率和 2.25 美元的每股盈餘？

Well, we're not changing our longer-term forecast at this moment, but 5% is still our target. We need to get through this pricing season, see how the membership is going to develop as we then look at '26, '27, and '28, we'll revise as necessary. But at this point in time, we're not changing our point of view.

嗯，我們目前不會改變我們的長期預測，但 5% 仍然是我們的目標。我們需要度過這個定價季，看看會員人數將如何發展，然後我們再看看 26、27 和 28 年，我們會根據需要進行修改。但目前，我們不會改變我們的觀點。

And Josh, I'm just going to add that -- Josh, just to add that with respect to your questions about the risk adjustment payable. We're putting a table in the Q that shows you all the risk adjustment payables by year, so that it's easier for you guys to navigate that.

喬希，我只是想補充一點——喬希，只是想補充一下關於你關於風險調整應付款項的問題。我們在 Q 中放置了一個表格，向您顯示每年的所有風險調整應付款項，以便您更輕鬆地瀏覽。

And I would just say in terms of the risk adjustment payables, the adjustment that we recorded, obviously, from the market morbidity is hitting the current year risk adjustment payable, and there's really nothing about the prior year risk adjustment payable that changed other than the true-up I spoke to.

我只想說，就風險調整應付款項而言，我們記錄的調整顯然來自市場發病率，這影響了當年的風險調整應付款項，而除了我所說的真實情況外，上一年的風險調整應付款項實際上沒有任何變化。

Perfect.

完美的。

Michael Ha, Baird.

麥可·哈，貝爾德。

Hi, thank you. So last year, when you set your '27 EPS target, $2.25, I saw a number of multiyear upside levers from the hundreds of basis points of opportunity on fraud, waste and abuse, the PBM renegotiation, provider contract renegotiations, upside from ICHRA that could drive considerable earnings upside well above $2.25.

你好，謝謝。因此，去年，當您設定 27 年每股收益目標 2.25 美元時，我看到了許多多年的上行槓桿，這些槓桿來自數百個基點的欺詐、浪費和濫用機會、PBM 重新談判、供應商合約重新談判、ICHRA 帶來的好處，這些好處可能推動盈利遠高於 2.25 美元。

So with everything happening this year, the risk pool volatility, I was wondering if you could elaborate on what you view as multiyear earnings levers that may have been more longer dated that you may have had in your back pocket, but you could also pull forward and accelerate if needed? Like, how large and tangible are these opportunities?

因此，鑑於今年發生的一切，風險池波動，我想知道您是否可以詳細說明您認為的多年期盈利槓桿，這些槓桿可能比您口袋裡的更長，但如果需要，您也可以提前並加速？例如，這些機會有多大、有多切實？

All right. Hi. Mark here. We are continuing to accelerate wherever we can across the board, particularly around medical costs. So I would say that we still have opportunity, plenty of opportunity to do better. You saw the effects of our administrative cost reductions through AI. We're now deploying Agentic AI in the clinical space as we look at ways of directing people and helping people find the right care at the right time.

好的。你好。標記在這裡。我們將繼續在各方面加速推進，特別是在醫療成本方面。所以我想說我們仍然有機會，還有很多機會可以做得更好。您看到了我們透過人工智慧降低管理成本的效果。我們現在正在臨床領域部署 Agentic AI，尋找指導人們並幫助人們在正確的時間找到正確的護理的方法。

And so, all of those things are coming to play. And we still, Michael, believe we have a lot of opportunity, and we are pulling all levers as we can now to set up '26 and beyond as profitable years.

所以，所有這些事情都會發生。邁克爾，我們仍然相信我們有很多機會，我們正在盡一切努力，將 26 年及以後的年份打造成盈利年份。

Got it. Thank you. Just my follow-up question. Looking ahead to the back half of this year, your updated guide, I just wanted to hear your thoughts on, is there a chance that the risk pool could deteriorate further? Like, any additional potential shoots that could drop?

知道了。謝謝。這只是我的後續問題。展望今年下半年，您更新了指南，我只是想聽聽您的想法，風險池是否有可能進一步惡化？例如，還有什麼其他的潛在芽可能會掉落嗎？

I guess, four things that come to my mind are: number one, FTR rechecks? I know you're fine, but I'd be concerned if the broader market needs attrition. Number two, at the end of the year, SEP, if that drives more growth, how that could affect profitability? Number three, the duplicative membership CMS identified. And number four, the preemptive utilization in the fourth quarter. Just wondering these four items and if there are any others that might factor into your updated '25 guide?

我想，我想到四件事：第一，FTR 重新檢查？我知道你很好，但如果更廣泛的市場需要消耗，我會擔心。第二，如果到年底 SEP 能夠推動更多成長，這將如何影響獲利能力？第三，CMS 確定了重複的成員資格。第四，第四季的搶佔式利用。我只是想知道這四項以及是否還有其他任何內容可能會影響您更新的 '25 指南？

Yeah. Thank you. So let me start with FTR. So on FTR, we've been telling you that we see little risk to us from that particular initiative. And just to double-click into that, we had an initial list of members who had failed to file and reconcile, which was around 27,000 members. And a portion of those members have already lost their subsidy. And we saw the remainder of those that had failed to reconcile lose their subsidies as of August 1.

是的。謝謝。那麼就讓我從 FTR 開始吧。因此，關於 FTR，我們一直在告訴您，我們認為該特定舉措對我們幾乎沒有風險。只需雙擊一下，我們就會得到一份未能提交和核對的會員初始名單，大約有 27,000 名會員。其中一部分成員已經失去了補貼。我們看到，其餘未能達成和解的企業自 8 月 1 日起失去了補貼。

Importantly, though, 60% of that group actually did complete their file to reconcile process, which I think is compared to some concerns that that might be a very significant portion of people that are unable to file and reconcile. So for us, and if that's indicative of what others may see in the market, we feel like that's pretty positive news.

但重要的是，該群體中有 60% 的人確實完成了他們的文件和核對流程，我認為這與一些人的擔憂相比，即可能有相當大一部分人無法提交和核對。因此，對於我們來說，如果這表明了其他人在市場上看到的情況，我們會覺得這是非常積極的消息。

On dual eligibles, in terms of Medicaid and ACA, what we've heard from CMS is that for us, that's approximately 2.5% of our membership or just under 50,000 members. We don't know exactly yet which way those members are going to go, whether they're going to land in the ACA or Medicaid. But our understanding from the FAQs is that the member will have to take affirmative action in order to retain their ACA premium tax credit.

關於雙重合格者，就醫療補助和 ACA 而言，我們從 CMS 聽說，對我們來說，這大約占我們會員人數的 2.5% 或略低於 50,000 名會員。我們還不清楚這些會員究竟會選擇哪條路，是選擇 ACA 還是醫療補助。但我們從常見問題中了解到，會員必須採取積極行動才能保留其 ACA 保費稅收抵免。

So on balance, I think that would suggest that we would see more of those members tending to go back into Medicaid and away from the ACA. We've also heard from CMS that the 2.5% that we've seen in our book is consistent for the market. And so I think that they gave a press release previously that I think was based on '24 information. Looks like the '25 information is less significant in terms of those dual enrollments.

因此，總的來說，我認為這意味著我們將看到更多成員傾向於重返醫療補助計劃並遠離 ACA。我們也從 CMS 那裡聽說，我們在書中看到的 2.5% 與市場一致。所以我認為他們之前發布的新聞稿是基於『24』的訊息。看起來，就雙重註冊而言，『25 資訊不太重要。

And so we think this is a smaller exposure than maybe some have feared in terms of its exposure to losing that membership. And frankly, when we look at the utilization patterns of those individuals, they are higher on average than our book. And so there could be a little bit of benefit to morbidity if everyone in the market has seen similar patterns and those folks move from our books back into Medicaid.

因此，我們認為，就失去會員資格的風險而言，這一風險比一些人擔心的要小。坦白說，當我們觀察這些人的利用模式時，我們發現他們的平均利用率高於我們的帳簿。因此，如果市場上的每個人都看到了類似的模式，而這些人從我們的書中轉回醫療補助計劃，那麼發病率可能會有一點好處。

And with respect to the other things that you listed out, look, I think that SEP is moderating into the back half. We do have a fourth quarter increase in utilization. We think that that's possible, but we've pulled some levers that we think will offset the effects of that in our guidance. And so overall, we feel very good about that we've factored all those risks into our pricing for '26 and feel like we're on the path to return to profitability next year.

至於您列出的其他事項，我認為 SEP 正在緩和到後半部分。我們的利用率在第四季確實有所增加。我們認為這是可能的，但我們已經採取了一些措施，我們認為這些措施將抵消我們指導中這種影響。因此，總體而言，我們感到非常高興，因為我們已經將所有這些風險都納入了 26 年的定價中，並且感覺我們正走在明年恢復盈利的道路上。

Good. Thank you so much.

好的。太感謝了。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑、派珀·桑德勒。

Hi, guys. Thanks for the question. So I guess maybe first, can you just help us understand kind of the assumptions around returning to -- first of all, assumptions around market stabilization in '26, around returning to profitability in '26? And then just how do you kind of think about fortifying the balance sheet in the event that next year's expectation for profitability kind of surprises to the downside or is subject to adversity? Thanks.

嗨，大家好。謝謝你的提問。所以我想也許首先，您能否幫助我們了解有關恢復的假設——首先，有關 26 年市場穩定、26 年恢復盈利能力的假設？那麼，如果明年的獲利預期出現意外下滑或遭遇逆境，您會如何考慮加強資產負債表？謝謝。

Yeah. Look, I would say that for 2026, we -- as Mark talked about in his prepared remarks, we have built in, I think, fairly conservative assumptions about the impacts of program integrity, the impacts of this market morbidity shift, trend. All those things have been baked in. When we access information that we're able to get in terms of what does the competitive pricing landscape look like, we see higher -- very conservative rate actions from the larger carriers. And those -- we've all been more competitive historically, but we are certainly seeing very significant increases in prices next year to capture the impacts of the things that I just spoke about.

是的。聽著，我想說，對於 2026 年，正如馬克在他的準備好的發言中談到的那樣，我們已經建立了相當保守的假設，關於項目完整性的影響、市場發病率轉變趨勢的影響。所有這些東西都已經融入其中了。當我們取得競爭定價格局的資訊時，我們發現大型承運商的費率更高，而且非常保守。從歷史上看，我們的競爭力一直都比較強，但明年我們肯定會看到價格大幅上漲，以反映出我剛才談到的那些事情的影響。

So we feel like the pricing is contemplating the risks that are out there. So that gives us a strong expectation that we'll be able to both improve our margin from this year, obviously, and return to profitability.

因此，我們覺得定價是考慮到了存在的風險。因此，我們強烈期望從今年開始我們能夠提高利潤率，並恢復獲利能力。

And then your question, with respect to what happens in a down scenario from a cash and capital perspective, I would just say this. We feel like the company right now has a strong capital position. We feel like if we are at need to access capital that we'll have access for additional -- we have virtually no leverage in the company, we feel like we could add additional leverage, and we believe that we would have access to capital as needed.

然後你的問題是，從現金和資本的角度來看，在下行情況下會發生什麼，我只想這樣說。我們感覺該公司目前擁有強大的資本實力。我們覺得，如果我們需要獲得資金，我們就能獲得額外的資金——我們在公司幾乎沒有任何影響力，我們覺得我們可以增加額外的影響力，而且我們相信，我們可以根據需要獲得資金。

Got it. And then I just have a follow-up. So we understand there was a large issuer that submitted data late -- risk adjustment data late for 2024. I don't think that other issuers will be penalized for that late submission. But just curious, if the data in that submission had been contemplated in 2024, would your risk adjustment payable as a percent of premiums have been larger and make '25 look smaller as a percent of premiums on a relative basis? Thanks.

知道了。然後我再跟進。因此，我們了解到有一家大型發行人延遲提交資料——​​2024 年的風險調整資料延遲提交。我認為其他發行人不會因為延遲提交而受到處罰。但只是好奇，如果該提交的數據是在 2024 年考慮的，那麼您應付的風險調整佔保費的百分比是否會更大，並且使 25 年佔保費的百分比在相對基礎上看起來更小？謝謝。

Yeah. We did see that true up. It was single -- small single-digit millions. It really didn't have any impact.

是的。我們確實看到了這一點。金額只有幾百萬。它確實沒有任何影響。

Awesome. Thank you.

驚人的。謝謝。

John Ransom, Raymond James.

約翰·蘭塞姆、雷蒙·詹姆斯。

Hey, good morning. I know things have changed, but when you were forecasting the market without enhanced subsidies, your number was about 21 million people. I mean, we've seen some other numbers that say the marketplace might shrink by 40% or so. Kind of where do you stand in that debate as we sit now?

嘿，早安。我知道情況已經發生了變化，但是當您預測沒有增加補貼的市場時，您的數字是大約 2100 萬人。我的意思是，我們看到一些其他數據表明市場可能會萎縮 40% 左右。就我們現在所討論的問題而言，您的立場是什麼？

As we look today, John, we believe that our 18% that we projected in our long-term guidance is the bottom and that it will probably be higher. Again, we need to see how the rates play out in the marketplace. We have a good handle on program integrity efforts and that impact, but it will be higher than the 18% we had originally projected.

約翰，就我們今天的情況來看，我們認為我們在長期指導中預測的 18% 是最低水平，而且可能會更高。再次，我們需要觀察利率在市場上如何表現。我們對專案完整性工作及其影響有很好的把握，但它將高於我們最初預期的 18%。

So, what do you mean by the 18%? I'm sorry, just to clarify that.

那麼，18% 是什麼意思呢？很抱歉，我只是想澄清一下。

We had an 18% reduction in the book as a result of what was going to happen with -- right? And so, we're still projecting in our numbers, no enhanced subsidies, and we were projecting 18%. We believe our number will be larger than 18%, but we haven't pegged it until we see rates and market competitiveness by market.

由於即將發生的情況，我們的帳面價值減少了 18%——對嗎？因此，我們仍然預測，不會增加補貼，我們預期補貼率為 18%。我們相信我們的數字將大於 18%，但在我們看到各個市場的利率和市場競爭力之前，我們不會確定這個數字。

Okay. I got you. And then just secondly, if we assume the MLR comes in line and you're going to accrue at about 15.5% for risk adjustment. So that implies that your medical margin is down about, call it, 600 basis points this year over last year. As you think about next year, how much of that margin do you think you can recover with pricing actions? And when you talk about profitability, is that EPS profitability, EBIT, EBITDA? Just some clarity on that would be great. Thanks.

好的。我接到你了。其次，如果我們假設 MLR 符合要求，那麼您的風險調整率將達到約 15.5%。這意味著今年的醫療利潤比去年下降了約 600 個基點。考慮到明年，您認為透過定價行動可以恢復多少利潤？當您談到獲利能力時，是指每股盈餘獲利能力、息稅前利潤 (EBIT) 還是息稅折舊攤提前利潤 (EBITDA)？只要對此進行一些澄清就好了。謝謝。

Yeah. Thank you. When we're kind of working backwards, when we talk about profitability, we're always talking about earnings from operations. And earnings from operations means that adjusted EBITDA will also be positive. With respect to the MLR, the comparisons are impacted by looking at year over year, there was a 630-basis-point year-over-year increase on the first half. And as you think about the second half and what that means, last year, we had a significant amount of SEP growth in the second half.

是的。謝謝。當我們反向思考時，當我們談論獲利能力時，我們總是談論營業利潤。營業利潤意味著調整後的 EBITDA 也將為正值。就MLR而言，與去年同期相比來看，上半年年增了630個基點。當你思考下半年及其意義時，去年下半年我們的 SEP 成長顯著。

And this year, we're expecting membership to basically trend down to the back half of the year. And so, we think that as we look at kind of adjusting for the relative growth in the book last year to this year, we would expect MLR trends in the back half of the year to -- the MLR is going to increase sequentially from the adjusted MLRs that I mentioned in the call. But we think that that trend is going to look a lot more like '23, maybe '22 than what it was last year, because last year, we had so much growth that really drove that.

今年，我們預計會員數在下半年基本呈下降趨勢。因此，我們認為，當我們調整去年和今年的帳面相對增長時，我們預計下半年的 MLR 趨勢將 - MLR 將從我在電話會議中提到的調整後的 MLR 連續增加。但我們認為，與去年相比，這一趨勢將更像 23 年，也許是 22 年，因為去年，我們的成長非常快，這才是真正推動這一趨勢的原因。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Just a couple of quick follow-ups first, I guess, on the second half MLR commentary. I guess, first, there's an announcement from CMS about potential scrubbing of duplicative enrollment. I guess, I would be curious to get your guys' perspective on what you feel like the impact from that might be? And if you're assuming anything for that in this guidance?

我想，首先對下半場 MLR 評論進行一些快速的跟進。我想，首先，CMS 發布了關於可能取消重複註冊的公告。我想，我很好奇想聽聽你們的看法，你們認為這可能會產生什麼影響？您是否在本指南中對此做出任何假設？

And then on the second question, the fourth quarter provision you mentioned for some additional utilization. Can you help us think about the magnitude of that? And then I have a couple of quick follow-ups.

然後關於第二個問題，您提到的第四季度準備金有一些額外的用途。您能幫助我們思考這件事的重要性嗎？然後我還有一些快速的後續問題。

Yes. So on the dual eligible enrollees, as we talked about, we know the membership. We know the number. For us, that's less than 50,000 members that potentially could end up moving back to Medicaid and losing their -- or losing their subsidy. I guess they could pay out of pocket, but they would lose their subsidy if they can't validate that they're no longer eligible for Medicaid or other Medicaid programs.

是的。因此，對於雙重合格登記者，正如我們所討論的，我們知道會員資格。我們知道這個數字。對我們來說，這意味著最終有不到 50,000 名會員可能會重新加入醫療補助計劃並失去他們的福利或失去他們的補貼。我想他們可以自掏腰包，但如果他們無法證明自己不再有資格享受醫療補助或其他醫療補助計劃，他們就會失去補助。

I think it's important to note that we understand from CMS that the 2.5% that we see in our book is also the similar number in the marketplace. So probably a smaller exposure than what many had feared. So we factor -- we think that regardless of the outcome of which direction those members end up moving, we're well within the range of our guidance. And so that's what I would expect on that component.

我認為值得注意的是，我們從 CMS 了解到，我們在書中看到的 2.5% 也是市場上類似的數字。因此，實際暴露程度可能比許多人擔心的要小。因此，我們認為，無論這些成員最終朝哪個方向發展，我們都在我們的指導範圍內。這就是我對該組件的期望。

With respect to the fourth quarter increase in utilization, I won't dimension it specifically other than to say that we are -- we did build that into our guidance. We think that a lot of the levers that I talked about last quarter around what do we do when we see increases in utilization, we've been working those levers, things like leaning into some fraud waste and abuse investments that we can make, ensuring that we are fully and correctly applying our provider contracts.

關於第四季度利用率的成長，我不會具體衡量它，只是說我們確實將其納入了我們的指導中。我們認為，我上個季度談到的許多槓桿都圍繞著當利用率增加時我們該做什麼，我們一直在利用這些槓桿，比如傾向於我們可以進行的一些欺詐浪費和濫用投資，確保我們全面正確地應用我們的供應商合約。

There are issues that we know where in our systems that we may not be -- we may be overpaying in spots. And so we are working to always address those. I think that's common for all insurers, but we see opportunities there. So we leaned into all those things which we think will help to moderate some of the back half pressure that we've otherwise built into the outlook.

我們知道系統中存在一些問題，但我們可能沒有意識到——我們可能在某些地方支付了過高的費用。因此，我們一直在努力解決這些問題。我認為這對所有保險公司來說都很常見，但我們也看到了機會。因此，我們傾向於考慮所有這些因素，我們認為這些因素將有助於緩解我們在前景中產生的部分後半部分壓力。

Got it. Okay. And then just to hopefully add a little bit of clarity to some of the repricing and refiling discussions. So appreciating that I think in use, the vast, vast majority of your membership is now refiled rates for. Have you gotten assurances or any kind of clarity from the states about what they're willing to accept?

知道了。好的。然後希望能為一些重新定價和重新提交的討論增加一點清晰度。因此，我很感激，我認為在使用中，絕大多數會員現在都已重新提交了費率。您是否從各州獲得了關於他們願意接受什麼的保證或任何明確的說明？

Like, have most states said like we will accept what you will submit? Or are you still expecting there's going to be a significant amount of scrutiny around the assumption changes that you're making? I want to just get a sense of how confident you are that the request changes you've made will actually end up going through.

例如，大多數州是否都表示我們會接受您提交的內容？或者您是否仍預期您所做的假設變更將會受到嚴格的審查？我只是想了解一下，您對您提出的請求變更最終能否順利完成有多大信心。

Yeah. Thanks, Steve. We have filed and we have had good conversations with the regulators. They have been accepting of our point of view and actually have been pushing in a few places to say, are we all priced properly.

是的。謝謝，史蒂夫。我們已經提交申請並與監管機構進行了良好的對話。他們已經接受了我們的觀點，並且實際上已經在一些地方推動我們說，我們的定價是否合理。

They don't want their markets to fail. That causes them to have to move membership, which they don't like to do. So they're very interested in making sure that we're priced properly.

他們不希望自己的市場失敗。這導致他們不得不轉移會員資格，而這是他們不喜歡做的事。因此他們非常希望確保我們的定價合理。

As you know, subsidies change with those kind of rates as well. And so we believe for individuals, it won't be as dramatic a change for them. But we believe we have pretty much received all the right messages from regulators that we're fine with our pricing models. And we believe everybody else is pricing rationally as well. I know there's some data out there from yesterday.

如您所知，補貼也會隨著這些費率的變化而變化。因此我們相信，對於個人而言，這不會是一個巨大的改變。但我們相信，我們已經從監管機構收到了所有正確的訊息，即我們對我們的定價模式感到滿意。我們相信其他人的定價也都是合理的。我知道那裡有一些昨天的數據。

It's not complete. There are a couple of markets where we've already filed where they have not updated the files online. So we are confident and our pricing includes everything we need to include.

這並不完整。我們已經向幾個市場提交了申請，但他們尚未在線更新文件。因此我們有信心，我們的定價已包含我們需要包含的一切。

Jonathan Yong, UBS.

瑞銀集團的喬納森楊（Jonathan Yong）。

I just wanted to go to your commentary on getting back to profitability in '26. I guess as you kind of think about where your peers are kind of shaking out at your pricing, their pricing, is there a level of enrollment where perhaps they're leaving a lot more enrollments to be left to the rest of the marketplace and where perhaps you absorb perhaps too much enrollment? Is there kind of a breakpoint where you just say, okay, this is just way too much. Can you frame that for us?

我只是想聽聽你關於 26 年恢復盈利的評論。我想，當您思考您的同行對您的定價、他們的定價進行何種程度的震盪時，是否存在一個招生水平，在這個水平上，他們可能會把更多的招生留給市場的其他部分，而您吸收了太多的招生？是否存在一個斷點，讓你說，好吧，這實在是太多了。你能為我們設計一下嗎？

Yes. We have been very careful not to create adverse risk coming into our pool from others. And so our pricing has been very careful on metal levels, types of products. We have a new strategy, a couple of new strategies we've exercised in markets that are not the traditional strategies you've seen in the markets to avoid the things like adverse selection or adverse retention on the other side. So we believe we have picked the right spots by market at this point, and we are very aware of that issue.

是的。我們一直非常小心，避免其他人的不利風險進入我們的資金池。因此，我們的定價對金屬等級和產品類型都非常謹慎。我們有一個新策略，我們在市場上實施的幾個新策略不是您在市場上看到的傳統策略，以避免逆向選擇或逆向保留等問題。因此，我們相信我們現在已經選擇了正確的市場位置，並且我們非常清楚這個問題。

It was a constant part of our conversation. We've had multiple pricing meetings, probably more than anybody would want to actually attend, but we have to make sure we're in the right place.

這是我們談話中經常出現的一部分。我們已經召開了多次定價會議，可能比任何人實際想要參加的都要多，但我們必須確保我們在正確的地點。

Okay. And then as we kind of think about the G&A reductions that you're doing to set yourself up to '26, kind of can you talk to like where exactly these are kind of taking shape in terms of those cost reductions? And then I guess, similarly, is that $60 million the needed level to get to the level of profitability? Or is that -- if you didn't do this, would you actually hit that?

好的。然後，當我們思考您為實現 26 年目標而採取的 G&A 削減措施時，您能否談談這些成本削減的具體進展？然後我想，同樣地，6000 萬美元是達到盈利水平所需的水平嗎？或者說——如果你不這樣做，你真的會打那個嗎？

Yes. I appreciate the question, Jonathan. And I would just say, the action we take is just as we've seen the losses that we're now projecting for '25, we wanted to make sure that we just solidified our profitability position next year. So we just view this as one of the levers that we're pulling to ensure we hit profitability and have meaningful margin expansion next year.

是的。我很感謝你提出這個問題，喬納森。我只想說，我們採取的行動就像我們看到的現在預測的 25 年的損失一樣，我們希望確保明年鞏固我們的獲利地位。因此，我們只是將此視為確保明年獲利並實現利潤率大幅擴張的槓桿之一。

So with regards to the nature of the savings, we are having a reduction in force, which is roughly half of the savings were projected for next year. The other half is driven by a mixture of closing some open roles that we had planned as well as reducing some vendor costs. So the majority of those savings will roll into '26, but we will see some of that in the back half of this year, which is part of the improvement in our SG&A guidance for the full year '25.

因此，就節省的性質而言，我們正在裁減人員，這大約是明年預計節省人數的一半。另一半則是由我們計劃關閉一些空缺職位以及降低一些供應商成本所驅動。因此，大部分節省的資金將進入 26 年，但我們將在今年下半年看到其中一部分節省的資金，這是我們對 25 年全年銷售、一般及行政費用 (SG&A) 指導改善的一部分。

And the focus has been on fixed costs. We assume there may be variable cost changes depending on where membership ends up, and we have not taken those actions yet.

重點一直放在固定成本。我們假設根據會員最終歸屬的不同，成本可能會發生變化，但我們尚未採取這些行動。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Can you help us bridge the $907 million of excess capital at Q1 to the $577 million of excess capital you quoted today? I think the earnings revision was $500 million. The risk adjustment payable accrual increased and minimum capital is presumably increasing with a higher premium. So I just want to understand what's getting better in the capital bridge and what the capital commitments look like for the back half of the year.

您能幫助我們將第一季的 9.07 億美元過剩資本與您今天報價的 5.77 億美元過剩資本進行彌補嗎？我認為獲利修正值為 5 億美元。風險調整應付金額增加，最低資本預計會隨著保費的增加而增加。所以我只是想了解資本橋樑有哪些進展，以及今年下半年的資本承諾如何。

Yes. So in terms of the decreases in capital, I would just point you to the loss that we recognized in the second quarter as being the biggest driver of the decrease in excess capital. We always have cash that's going back and forth between the subs and the parent. So for example, parent cash increase in the second quarter, that was due to some tax sharing payments that moved from the subsidiaries up into the parent. That also affects kind of the amount of excess capital at the subs. So that's the picture of where we are.

是的。因此，就資本減少而言，我只想指出，我們在第二季確認的損失是過剩資本減少的最大驅動因素。我們總是有現金在子公司和母公司之間來回流動。例如，第二季母公司現金增加，這是由於部分稅收分成支付從子公司轉移到母公司。這也會影響子公司的過剩資本數量。這就是我們所處位置的景象。

As I already spoken to, with respect to cash and capital, we are very comfortable with our current position. We have a revolver that's expiring at the end of the year. So we're actively working towards extending and improving that facility. And overall, we feel very confident that we will have -- we have the right capital and should we need, whether it's for growth reasons or otherwise, to increase our capital position. We have a fairly unlevered balance sheet, and we think that we would have ready access to be able to improve our capital position as necessary.

正如我已經說過的，就現金和資本而言，我們對目前的狀況非常滿意。我們有一把左輪手槍，有效期到年底。因此，我們正在積極努力擴大和改善該設施。總體而言，我們非常有信心，我們擁有適當的資本，無論出於成長原因還是其他原因，我們都可以增加我們的資本狀況。我們的資產負債表相當無槓桿，我們認為我們可以隨時根據需要改善我們的資本狀況。

Great. Can I just ask a few follow-ups on that? One, can you give us the level of minimum cash you'd like to retain at the parent? And two, just a follow-up on the risk adjustment. It looks like the year-to-date accrual is running around 15.5%.

偉大的。我可以就此再問幾個問題嗎？第一，您能否告訴我們您希望在母公司保留的最低現金水準？第二，只是風險調整的後續行動。看來年初至今的應計額約為 15.5%。

Is that a good number to think about for the back half accrual as well? And can you help us understand why that number wouldn't increase more year over year if market acuity is increasing?

對於後半部應計項目來說，這也是一個值得考慮的好數字嗎？您能否幫助我們理解，如果市場敏銳度不斷提高，為什麼這個數字不會逐年增加？

Yes. So on the parent cash levels, we have internal targets that we maintain. I would say that currently, we are well above our internal targets and are comfortable with the cash position at the parent even through the second half of this year. With respect to the risk adjustment, I think that the first half is reflective of the change in market morbidity.

是的。因此，在母公司現金水準上，我們有維持的內部目標。我想說的是，目前，我們的現金狀況遠超過內部目標，即使到了今年下半年，母公司的現金狀況也令人放心。關於風險調整，我認為上半年反映了市場發生率的變化。

So it is now consistent. It's a good proxy for the back half as well. We had seen elevated claims and expected that we would see some risk adjustment offset for those. Obviously, now we know that we're not going to see that full offset. But at this point, we are -- we've adjusted for the market morbidity change, and that's fully reflected in the amount of risk adjustment that we're projecting in our guidance.

所以現在是一致的。這對於後半部分來說也是一個很好的代理。我們已經看到索賠金額增加，並預計會看到一些風險調整抵銷。顯然，現在我們知道我們不會看到完全抵消。但此時，我們已經根據市場發病率的變化進行了調整，這完全反映在我們在指導中預測的風險調整量中。

Craig Jones, Bank of America.

克雷格瓊斯，美國銀行。

So when you're thinking about where you end up among your peers in each state in terms of the rate increase requested for 2026, as you refile in each state, there's a pretty wide range of rate increases requested. So are you targeting getting towards the higher end of rate increases in each state to be more conservative in 2026 with the risk pool potentially changing so significantly? Are you sort of more -- are you plenty comfortable in the mid- to low end of rate increases and are just confident in the rate that you've requested?

因此，當您考慮 2026 年要求的稅率增長與各州同行相比處於什麼位置時，當您在每個州重新提交申請時，要求的稅率增長範圍相當廣泛。那麼，在風險池可能發生如此大的變化的情況下，您是否計劃在 2026 年將各州的利率提高到更高的水平，從而更加保守？您是否對中低端利率成長感到滿意，並且對您要求的利率有信心？

Yes. So as you might expect, we start with what do we believe we need to do to put ourselves in the right position to ensure that we are confident that we are covering the changes in market morbidity, the impacts of subsidies expiring, enhanced subsidies. And so we build up our price first just based on our own detailed modeling. That gets us into double-digit increases and significant double-digit increases in some of our biggest markets.

是的。因此，正如您可能預料的那樣，我們首先要考慮的是，我們認為我們需要做什麼才能使自己處於正確的位置，以確保我們有信心涵蓋市場發病率的變化、補貼到期的影響以及補貼增加。因此，我們首先根據我們自己的詳細模型來確定價格。這使得我們的一些最大市場實現了兩位數的成長，而且成長幅度還達到了顯著的兩位數。

When we look at how our price position looks compared to what we're seeing with competitors, we think that we're very competitive in some markets. We're less competitive in others. On average, we feel very comfortable that our price change is going to be comparable to some of our larger peers and that we have covered off the risk that we see.

當我們將我們的價格定位與競爭對手的價格定位進行比較時，我們認為我們在某些​​市場上非常具有競爭力。在其他方面，我們的競爭力較弱。平均而言，我們感到非常放心，我們的價格變化將與一些較大的同行相當，並且我們已經消除了我們看到的風險。

Okay. Great. That makes sense. And then just to clarify, when you say double digits, is that between 10% and 99%? Or what's -- can you narrow that down for us a little bit?

好的。偉大的。這很有道理。然後澄清一下，當您說兩位數時，是指 10% 到 99% 之間嗎？或者是什麼－您能為我們稍微縮小一下範圍嗎？

I would say that you are correct in terms of that number could be any of those. But I would just say that we would expect that in '26, we'll see rate increases that will be multiple times what we saw last year.

我想說你是對的，因為這個數字可以是其中任何一個。但我只想說，我們預計 26 年利率的漲幅將是去年的數倍。

Dave Windley, Jefferies.

戴夫溫德利 (Dave Windley)，傑富瑞 (Jefferies)。

I wondered if you could talk to the membership shifts that you are seeing. I think from the beginning of the year, your membership has obviously held up better than the original expectation. In that gain, are those SEP like new signees? Or are they switchers from other plans? And what do the -- what is the profile of those members that are switching to -- or are shifting to your book, one way or the other?

我想知道您是否可以談談您所看到的會員變化。我認為從今年年初開始，你們的會員人數顯然比最初的預期要好。在那項收益中，那些 SEP 是否像新簽約者一樣？還是他們是從其他計劃轉換過來的？那麼，那些轉向閱讀您的書的會員的個人資料是怎樣的呢？

Yes. So I would say part of the improvement in membership is actually stronger retention and lower lapse. So it's not all from new membership. We do have growth in SEP. We see a good portion of that growth is in $0 plans.

是的。所以我想說會員人數的提高部分實際上是提高了保留率並降低了流失率。所以這並不全是來自新會員。我們的 SEP 確實有所成長。我們發現，很大一部分成長來自 0 美元計劃。

I think that many of the dynamics that have fueled growth last year continue to persist this year. We are comfortable that the members that we've added have MLR profiles that are consistent with our historical expectations that they'll be modestly higher than what we see for the full book, and that's kind of what we've seen thus far in '25.

我認為，去年推動成長的許多動力今年將繼續存在。我們感到欣慰的是，我們添加的成員的 MLR 概況與我們的歷史預期一致，即它們將略高於我們所看到的全書，這也是我們在 25 年迄今為止所看到的情況。

And as we talked about with utilization, we have seen that settling down to levels that are approaching our expectations for what we should see for the risk in the book. So I don't think that we see any kind of signals that these members that we're adding this year are driving some types of adverse selection or increased risk for market morbidity.

正如我們討論利用率時所見，我們已經看到利用率穩定在接近我們對帳簿中風險的預期水準。因此，我認為我們沒有看到任何訊號表明我們今年增加的這些成員正在推動某些類型的逆向選擇或增加市場發病率的風險。

Okay. Got it. My follow-up question was going to be on the very last part of what you said. So it seems like better retention or switching of perhaps price-sensitive members to you, helps to perhaps maintain the risk profile of your book, but perhaps to the detriment of your peers' books that are losing members aren't in benchmark position, et cetera. Bottom line seems like the issue for assessing the market here, particularly for price leaders in the market is not so much your own book, but everybody else's book.

好的。知道了。我的後續問題是關於您所說的最後一部分。因此，看起來，更好地保留或轉換可能對價格敏感的會員，可能有助於維持您的帳簿的風險狀況，但可能會損害您的同行的帳簿，因為失去的會員不在基準位置，等等。底線似乎是評估這裡的市場的問題，特別是對於市場上的價格領導者來說，不是你自己的書，而是其他人的書。

And so I wonder how you get comfortable with that pattern not persisting through the balance of this year and further into next year in terms of just market morbidity continuing to deteriorate away from you as people get swept out of the market with the enhanced integrity. You've addressed a lot of this, but I just wondered if we could put a finer point on it.

因此，我想知道，您如何適應這種模式，使其不會持續到今年年底，也不會持續到明年，因為隨著誠信的增強，人們會被市場淘汰，市場病態會繼續惡化。您已經談了很多這個問題，但我只是想知道我們是否可以對此進行更詳細的闡述。

Sure. And I would just say this, the increased program integrity rules have already been put into place for '25. We think that's been -- the effects of that have already manifested in terms of what we see in the first quarter change in market morbidity.

當然。我只想說，針對 25 年的增強的程序完整性規則已經實施。我們認為，從第一季市場發病率的變化來看，其影響已經顯現。

With respect to the population of low to no utilizers, we just really haven't seen much of a shift in our book. We've seen actually quite consistent percentages of those members in our book consistent with last year. In fact, it's been consistent with a number of years. So we're not really seeing anything in that, that gives us great pause and concerns about kind of what's going on with market morbidity.

對於低利用率或無利用率人群而言，我們確實沒有看到太多變化。實際上，我們發現這些成員的比例與去年相比相當一致。事實上，這種情況多年來一直保持一致。所以我們其實並沒有看到任何跡象，這讓我們非常擔憂市場病態的現況。

I read, I see what others are saying in terms of the potential shifts there. We acknowledge that, that could be a source of pressure and part of the driver of market morbidity. But we don't see anything in our statistics through the second quarter that caused us to think that there's another leg that's going to drop in terms of market morbidity.

我讀過，也看到了其他人對那裡的潛在轉變的看法。我們承認，這可能是壓力的來源，也是市場病態的部分驅動因素。但從第二季的統計數據來看，我們並沒有看到任何跡象顯示市場發生率還會進一步下降。

There are no further questions at this time. Ladies and gentlemen, this concludes today's conference call. We thank you for participating and ask that you please disconnect your lines.

目前沒有其他問題。女士們、先生們，今天的電話會議到此結束。感謝您的參與，並請您斷開線路。