A new report by the Economic Policy Innovation Center (EPIC) reveals that the total revenues of the nation’s largest health insurance companies have tripled over the last decade, revealing a huge contrast between corporate prosperity and soaring consumer healthcare costs.
The findings come amid intense political pressure on the industry, spearheaded by President Donald Trump’s administration, which has directly attacked insurers over their profits and their role in the Affordable Care Act (ACA) market.
The EPIC report, “Health Insurance Revenues Tripled in a Decade,” documented that the combined revenues reported in the financial filings of the seven largest health insurance companies—Centene, Cigna, CVS Health/Aetna, Elevance, Humana, Molina, and UnitedHealth Group—jumped from $511 billion in 2014 to $1,517 billion in 2024.
During that 10-year period, these companies collectively garnered $10.4 trillion in total revenue. The sources note that the stock prices of these companies have soared at an even higher rate than their revenues, significantly outpacing the S&P 500.
This exponential growth in revenue and profit trends is deeply intertwined with the full implementation of the Affordable Care Act (ACA) in 2014. Since the ACA was passed in 2010, more than $9 trillion of revenue has flowed to the country’s largest health insurance companies., according to data examined by investigative newsroom The Lever.
On top of that the annual profits of the top five U.S. health insurers jumped significantly since the ACA’s passage. Insurers gained these profits as the ACA created an individual mandate for Americans to buy insurance and included large government subsidies for those policies.
The industry’s expansion has also been fueled by mergers and the law’s subsidies, which helped Americans purchase private insurance. Overall, America’s largest health insurers have collectively raked in more than $371 billion in profits since the ACA’s passage, The Lever reports.
While insurers have benefited, average American families have faced rising costs. The average family premium for employer-sponsored health insurance rose 7 percent to just under $26,000 per year in 2024. Since 2014, the average family premium cost has risen 52 percent, outpacing inflation. Patients are also grappling with rising out-of-pocket costs and mounting medical debt, with nearly one in every 12 Americans now having medical debt.
Leading the trend in revenue and profits is UnitedHealth Group (UHG), the nation’s largest health insurer, which has seen its annual profits skyrocket by nearly 400 percent since the ACA’s passage. More than 40 percent of the total net income earned by large insurers since the ACA went to UHG.
UHG’s annual results for 2024 reported $14.4 billion in profits, including $5.5 billion in the fourth quarter. While total revenue still jumped 8 percent to $400.3 billion, the $14.4 billion net income was the lowest annual income in five years, down from more than $22 billion in 2023.
That number would surely have been higher if it were not for a cyberattack on its Change Healthcare business, which cost the company’s businesses more than $3 billion combined, and higher-than-normal costs from treating a surge of patients, particularly seniors in Medicare Advantage plans.
In a statement accompanying the earnings report, Andrew Witty, chief executive officer of UnitedHealth Group, said: “The people of UnitedHealth Group remain focused on making high-quality, affordable health care more available to more people while making the health system easier to navigate for patients and providers, positioning us well for growth in 2025.”
There is heightened scrutiny over the company’s patient practices, as UHG reportedly denies nearly one in three medical claims from its policyholders.
The massive financial scale of the insurance industry has made it a primary target for political scrutiny, particularly from Trump. While pharmaceutical companies have managed to secure deals with the Trump administration in exchange for tariff reprieve, health insurers have been on the “receiving end” of his populist attacks.
Trump has publicly criticized the industry for relying on Obamacare funding. He notably contrasted his treatment of insurers with pharmaceutical drugmakers, whom he called “great talented people” and friends, saying he didn’t begrudge them their profits because their companies were “doing very well.”
The main battleground between the insurers and the administration centers on the Obamacare subsidies, which were enhanced during the pandemic. Insurers are lobbying aggressively for an extension of these enhanced subsidies, a key Democratic demand in recent government shutdown fights. AHIP, the health insurers’ trade association, ramped up its lobbying expenditures, spending over $4.2 million from July to September alone.
Trump, however, has urged Congress to scrap the current subsidy structure and move funds directly to patients. In a post on Truth Social, he wrote: “Take from the BIG, BAD Insurance Companies, give it to the people, and terminate, per Dollar spent, the worst Healthcare anywhere in the World, ObamaCare.”
If Congress fails to act, the enhanced ACA subsidies will revert to 2010 levels, resulting in significant consumer impacts. A KFF analysis estimates that insurers have already raised premiums by 26 percent on average on the ACA marketplaces for 2026. The looming fiscal hit, combined with the expiration of subsidies, could cause 4 million Americans to lose coverage, according to the Congressional Budget Office (CBO).
As affordability pressures mount, the political spotlight on insurers is expected to intensify. As one insurance lobbyist told Politico candidly: “You’re going uphill against a party and a president that doesn’t look at the ACA favorably and certainly doesn’t look at changes that were made by Democrats and Biden favorably.”
One alternative to the world of big profit taking health insurance is health-sharing, where people come together to pool resources to cover medical costs, usually through Christian health care sharing ministries (HCSM).
HCSM’s are also engaged in the current debate over the future of American healthcare and are urging lawmakers in both houses to give them fair treatment through the Health Care Sharing Ministry Tax Parity Act.