“In five years, more than 100 million Americans could be buying coverage individually — with employer dollars simply funding the allowance.”
Mark Bertolini, CEO of Oscar Health on the Future of Healthcare: From Employer Plans to Individual Choice
Coverage from The ACA Way 2025, October 10, 2025 By Karie Orozco | Benafica ICHRA Sales Team
At The ACA Way 2025 Mark Bertolini, Chief Executive Officer of Oscar Health, shared an unfiltered view of where U.S. healthcare may be headed — and why he believes the next decade could blur the line between employer-sponsored and individual coverage.
Before joining Oscar in 2023, Bertolini served as CEO of Aetna and later Co-CEO of Bridgewater Associates, giving him a rare perspective across both healthcare and finance.
In a fireside chat with Tony Feijoo, President of New Health Partners, Bertolini described what he sees as a structural shift already underway.
How the ACA Flipped the Risk Mechanism
Bertolini explained that the Affordable Care Act fundamentally changed how insurance risk is distributed. Instead of underwriting individuals, carriers now underwrite provider networks. Risk is leveled across the marketplace through annual adjustments, which means plans are rewarded for building efficient, high-quality networks rather than avoiding high-risk members.
That shift, he said, has quietly stabilized the individual market. About 75 percent of all providers now participate in ACA networks, giving most consumers access to their preferred doctors and hospitals. “It’s the only place you can go buy a plan that truly fits you,” he said.
From Group Risk to Individual Choice
Traditional employer coverage, Bertolini argued, “hides risk” by pooling healthy and sick employees together and forcing uniform premiums. The individual market allows people to buy coverage that matches their own life and health circumstances — whether starting a family, planning surgery, or managing a chronic condition.
“When people pick the right plan, most end up paying less — sometimes 25 percent less — because it’s designed for them.”
That concept underpins the growing Individual Coverage HRA (ICHRA) model, which lets employers fund coverage without dictating a single group plan.
A Shift Measured in Millions
Bertolini estimated that roughly 79 million people in small- and mid-sized groups, 30 million gig-economy workers, and 5 million individuals transitioning from Medicaid could ultimately purchase coverage individually. “Add that up,” he said, “and you’re talking about more than 100 million Americans.”
Even Fortune 50 companies, he noted, are seeing double-digit renewal increases. “It just doesn’t work anymore.”
Technology as a Catalyst
Bertolini tied the movement to advances in AI and data automation. Oscar Health has deployed large-language-model systems for processes such as risk adjustment and prior authorization, lowering administrative costs and improving speed. Similar tools, he said, will make it easier for consumers to compare and manage their coverage.
The Role of Brokers and Advisors
For brokers, the change is not a threat but an evolution. As employees gain more freedom to choose plans, the need for expert guidance grows. Bertolini suggested brokers will shift from plan administrators to personal advisors, helping consumers understand networks, cost-sharing, and supplemental benefits.
Looking Ahead
“In five years, more than 100 million Americans could be buying coverage individually — with employer dollars simply funding the allowance.”
If that vision holds, the health-insurance system may function less like a collection of employer contracts and more like a connected marketplace — where technology, competition, and consumer choice define stability and innovation.
This recap reflects my takeaways from Mark Bertolini’s session at The ACA Way 2025.
