The Only Health Insurance Stock You Can Own with Michael Ha | The Real Eisman Playbook Episode 51

From bulletproof to broken

United Healthcare delivered 13-14% annual EPS growth for 15 years as a 'close your eyes' investment, but spiraled after unprecedented Q1 2025 guidance cuts and the murder of CEO Brian Thompson.

Optum's structural crack

The company slashed long-term targets for Optum Health—the division generating over half of earnings—which was previously considered untouchable and drove the company's decade-long growth engine.

Public relations nightmare

The company faced global scrutiny over claims denial practices (15-17% denial rate) and became 'the most hated company in the world' for months following viral reports of mid-surgery denials.

Medicare Advantage mechanics

Risk adjustment pays insurers using multipliers based on patient severity (average 1.0, up to 5.0 for complex conditions), but new Biden administration rules narrowed documentation 'gray areas' and lowered coding ceilings.

Devastating operating leverage

Optum Health operates on thin 8-10% terminal margins, meaning even small revenue reductions from stricter coding standards create disproportionate earnings pressure.

Permanent revenue impairment

Unlike temporary pricing issues, the risk model revisions represent structural changes that permanently reduce reimbursement for aggressively coded patient populations.

The DaVita acquisition timeline

Analysis of public CMS data revealed that in Los Angeles County—Optum's densest market with 3,000 doctors—risk scores remained flat at 1.0 for five years before United acquired DaVita Medical Group in 2019.

The 50% coding surge

Immediately following the acquisition, risk scores jumped 50% to 1.51 over five years, suggesting systematic upcoding that generated revenue flowing straight to the bottom line.

Hostile reception

Ha faced angry investors refusing to realize billions in losses and a soured corporate relationship after publishing his June 2025 downgrade exposing these coding practices.

The 'scorched earth' argument

Desperate investors claim United can raise prices in its traditional insurance business (short-tail allowing annual repricing) to offset Optum's structural decline while they wait to exit positions.

Fundamental misunderstanding

Long-term shareholders lack comprehension of Optum's value-based care model and risk adjustment mechanics, wrongly assuming pricing power can fix permanent coding revenue reductions.