Kaiser Foundation Hospitals and Risant Health face opposition to their request to modify the acquisition plan for Geisinger Indemnity Insurance Co. and related entities by lowering risk-based capital requirements.
The companies filed the modification request with the Pennsylvania Insurance Department on January 16, 2026. They cited a flat-rate proposal from the Centers for Medicare and Medicaid Services, higher specialty drug costs, changes from the One Big Beautiful Bill Act and other shifts in federal health programs.
Geisinger Health had invested $2.6 billion to expand prior to these developments.
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The original 2024 approval required Geisinger Indemnity Insurance Co. and Geisinger Quality Options Inc. to maintain risk-based capital at or above 400%. Geisinger Health Plans had to maintain it at or above 350% for the first five years after closing. The level would then fall to 350% for the entire enterprise.
Geisinger now seeks to set the requirement at or above 300% for all three entities for the first 15 years after the acquisition’s effective date. Filings indicate the adjustment would free up approximately $100 million in capital.
The level is 1.5 times higher than the National Association of Insurance Commissioners recommendation and matches historical requirements for the entities.
US insurance regulators adopted updated guiding principles for the risk-based capital framework in December 2025. Industry observers noted that the principles reaffirm RBC as an early-warning tool for identifying potentially weakly capitalized companies and emphasize equal capital for equal risk while guiding future modernization efforts.
Action Together NEPA submitted a letter opposing the change. The group noted that Geisinger received approval for substantial premium increases in 2025 while health insurance premiums and care costs rose.
It recommended denying the modification or pairing any approval with a commitment from Geisinger to reduce or freeze health care costs.
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SEIU Healthcare Pennsylvania, which represents 1,000 health care workers at two Geisinger facilities, also opposes the plan. The union said Geisinger union and nonunion employees saw health care costs increase 33% between 2023 and 2025.
It recommended that the department clarify how Geisinger would reallocate resources if requirements are lowered, examine using part of Kaiser’s $82 billion net worth to support access and affordability, and tie any approval to guarantees to reduce or freeze costs.
On March 12, Risant Health and Geisinger submitted a formal response to public comments. The companies stated that the modification request is narrowly focused on RBC requirements and does not seek to alter the department’s original findings on capital commitments or other conditions of the 2024 order.
Geisinger has stated the modification would allow more resources for care quality. The Pennsylvania Insurance Department has not yet ruled on the request.
