Big Insurance Earnings 2025: Stock Buybacks, Earnings Per Share, Market Capitalization

The seven largest for-profit health insurance conglomerates took in nearly $1.7 trillion from their customers in 2025 ($175 billion more than in 2024) and they booked more than $54 billion in profits.

Key Takeaways from yesterday’s story

In 2025, the seven biggest health insurance conglomerates:

• Collected almost $1.7 trillion in total revenues, $175 billion more than in 2024

• Made more than $54 billion in profits

• Covered 10 million fewer people than in 2024

• Ramped up their self-dealing by steering more of their health plan enrollees to physician practices, clinics, pharmacy operations and other clinical businesses they now own

• Took record amounts of money from state and federal governments. As a result:

  • UnitedHealthcare now gets more than 77% of its revenues from government programs even though it covers almost twice as many people in its commercial plans. That said, all of UnitedHealthcare’s enrollment growth since 2015 has been in Medicare Advantage and Medicaid. It covered 80,000 fewer commercial health plan enrollees in 2025 than it did in 2015. In addition:

  • UnitedHealth Group now classifies approximately 27% of its revenues as “intercompany eliminations.” That percentage has increased every year as UnitedHealthcare has steered more and more of its health plan enrollees (and their premiums) to health care delivery operations that Optum, its sister division, owns.

As we first published yesterday, the seven largest for-profit health insurance conglomerates took in nearly $1.7 trillion from their customers in 2025 ($175 billion more than in 2024) and they booked more than $54 billion in profits.

Today I will focus on the $12 billion of our premiums and other health care spending these companies used to buy back their own shares of stock to boost earnings per share, which benefits shareholders and top executives.

It’s important to note that since 2015 most of the seven companies have transformed themselves into diversified giants that have bought up much of the country’s health care delivery system. Since that year, they’ve spent more than $137 billion buying back shares. This vertical integration is now attracting the attention – and ire – of policymakers on both sides of the political aisle. Just this month, Senators Josh Hawley (R-Mo.) and Elizabeth Warren (D-Mass.) introduced the Break Up Big Medicine Act, which would make it illegal for one company to own and operate health insurance plans as well as PBMs, pharmacies, physician practices and other clinical operations. On the House side of Capitol Hill, Rep. Buddy Carter (R-Ga.) has repeatedly called for the breakup of UnitedHealth Group and other big vertically integrated companies. As Health Care un-covered reported last year, UnitedHealth Group alone now encompasses nearly 2,700 subsidiaries, most of which are health care delivery operations, not insurance.

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UnitedHealth’s enormous growth through thousands of acquisitions spurred its competitors to pursue a similar strategy. In 2018 alone, Cigna spent $67 billion to buy Express Scripts and CVS spent $69 billion to buy Aetna. (Note: In the charts, the 2015 numbers are for Aetna prior to its acquisition by CVS except for the stock buyback chart, which uses CVS’s buyback numbers for the entire period.)

Most of the other companies have also ventured into health care delivery as a way to capture more of what Americans spend on health care. This has enabled them to self deal in ways that are illegal in banking: Their insurance divisions can and do direct increasing percentages of their customers’ premiums to physician practices and other provider entities they now own. As an example, UnitedHealth Group now classifies approximately 27% of its revenues as “intercompany eliminations.” That percentage has increased every year as UnitedHealthcare has been able to steer more and more of its health plan enrollees to health care delivery operations that Optum, its sister division, owns. And recent research has shown that UnitedHealth pays the physician practices it owns 17% more on average than it pays physicians in independent practices – and up to 61% more in markets where it is dominant.

The industrywide vertical integration strategy seemed to be working well until last year when investors as well as lawmakers began to question that strategy. The companies’ profits (adjusted earnings from operations) more than doubled between 2015 and 2025, and until last year, earnings per share and market capitalization also increased dramatically.

Their market caps began to shrink several months ago as many investors reduced their holdings in the industry, sending the companies’ stock prices (and their C-suite executives’ net worth) to lows not seen in years. But keep in mind that even with the recent share price declines, shareholders have banked billions of dollars over the past decade.

One way insurers try to make sure that happens is by using much of the money we (and our employers and the government) send them to buy back millions of their own shares instead of reducing premiums and out-of-pocket requirements. Share buybacks artificially inflate a company’s earnings per share, which benefits shareholders and top company executives by reducing the number of shares outstanding. Each remaining share has a higher value. Between 2015 and 2025, the seven companies bought back more than $137 billion worth of their own shares.

Why should we care?

When I was an insurance industry spokesman, I used to defend my company’s profits by telling reporters that companies have to make a profit to stay in business, but never mentioning that not so many years ago, most Americans were covered by nonprofit health insurance companies. (As recently as 1994, all Blue Cross plans were operated as nonprofits.) That began to change when for-profit life insurance companies like Aetna and Cigna started selling cheaper policies to younger and healthier Americans, leaving nonprofits with more expensive older and sicker policyholders. That was unsustainable, so, starting with Blue Cross of California, several Blues converted to for-profit status, and even the ones that remained nonprofit adopted the same business practices as the for-profits to stay in business.

Fast forward three decades and you see what has happened. Giant for-profit conglomerates now dominate the health insurance market and own big chunks of our health care delivery system – and they have no real incentive to control health care costs. Because most Americans cannot enroll in a government-run program like Medicare, which has much lower administrative costs, rarely uses prior authorization and provides access to almost every doctor and hospital in the country, private insurers can and do conduct business the way they do to maximize profits for the benefit of shareholders. They have proven to be incapable of controlling the unit costs of health care goods and services like a prescription drug or a stay in the hospital, and they don’t even have a real incentive to do so because as those costs go up, they simply jack up premiums to more than cover the extra expense. So they focus their attention on making it harder for Americans to get the care they need.

As a consequence, we Americans spend far more on health care than people in any other country and a much higher percentage of GDP. We also go to the doctor less often than people in other developed countries, and we live shorter lives. But health insurance company executives and shareholders grow richer every year.

I’ve heard some people say that $54 billion in profits is just a small percentage of the nearly $6 trillion we spend overall on health care in the U.S., and that’s true, but it misses the point. Why do we have to maintain a system of health insurance in which corporate conglomerates control our access to care and make us pay more and more every year just so they can reward themselves and their shareholders more generously? At long last, both Republicans and Democrats are now asking that very question.