It’s not easy for Universal American (UAM) to compete against giant healthcare insurance providers like UnitedHealth, Humana and Cigna. Still, CEO Richard Barasch said his company does have some advantages because healthcare, like politics, is a local business. 'We are the largest Medicare HMO in Houston and in that market we have plenty of scale compared to the larger national companies,' said Barasch. 'We are the largest sponsor of ACOs (Accountable Care Organizations) throughout the country. It’s a niche business and we’ve developed a nice spot in that business that enables us to compete with the larger carriers.' Universal American, down 28% so far in 2015, is a Medicare Advantage company, which means that the government pays it a capitation rate for everyone who signs up with it to provide them coverage. The trade-off is that they are coming out of original Medicare in order to get more benefits inside of Medicare Advantage. 'What they give up is a little bit of flexibility on who they can go to. So we are private Medicare,' said Barasch. The company does not pay a dividend, but it has paid a series of special dividends. It has paid almost $20 per share worth of dividends to investors since 2011, according to Barasch.