The vast majority of Centene and Humana's $209 billion in revenues came from taxpayers.

Nearly 44 million Americans were enrolled in a Humana or Centene plan last year. But only 3.7 million were private-paying customers.

If you have been reading my analyses of large health insurers’ 2021 earnings reports, you know that the last 10 years have been incredibly profitable for the four biggest: Anthem, Cigna, CVS Health (which now owns Aetna), and UnitedHealth Group.

Today we’ll take a look at two other companies that round out the Gang of Six: Humana, where I used to work, and Centene, a company I hadn’t even heard of when I was at Humana and, I would wager, a company most Americans still haven’t heard of.

Like the other four, Humana and Centene raked in tens of billions of dollars last year and made their shareholders considerably richer. And like the other four, you and I contributed to those shareholders’ good fortune even if we weren’t enrolled in a Humana or Centene health plan. 

Humana is a far bigger company today than it was when I worked there. When I joined Humana in 1989, it was known as a hospital company that also had a small but growing managed care business. In 1993, my last year at the company, Humana executives decided they could make more money if they focused exclusively on health insurance, so they sold all 77 of the hospitals. (The buyers, by the way, were a group of investors led by a Texas businessman named Rick Scott. He would go on to become governor of Florida and a U.S. senator.)

For Humana’s shareholders, that was a pretty good business decision. In 1989, Humana took in something north of $4 billion in revenues. Last year, its total revenues exceeded $83 billion, and it made more than $3 billion in profits, up from $1.9 billion in 2010, the year the Affordable Care Act was passed.

As for Centene, the reason I hadn’t heard of it when I was at Humana was because it didn’t even exist, at least not by that name. The company was founded in 1984–the same year Humana got into the health insurance business– as a nonprofit Milwaukee-based Medicaid plan called Family Hospital Physician Associates. It was renamed Centene in 1997 and became a publicly traded company in 2001. 

Many mergers and acquisitions later, Centene has surpassed Humana in terms of revenues and health plan enrollment. Last year, Centene’s revenues totaled $126 billion, $43 billion more than Humana. More than 26.6 million people were enrolled in Centene operated-health plans at the end of last year. 9.5 million more than Humana’s 17.1 million. It made $1.8 billion in profits last year.

Together, nearly 44 million Americans were enrolled in a Humana or Centene plan last year. That’s a lot, for sure, but here’s the thing: only about 3.7 million were private-paying customers. 

Like the other four big insurers, Humana and Centene have seen little to no enrollment growth in either their individual or their employer-sponsored health insurance businesses over the past decade. In 2010, Humana reported a little more than 3 million people in the fully insured and employer-sponsored health plans it operated. By last year, the total had nosedived to 1.1 million. 

In 2010, Cenene had no commercial health plan enrollment at all. All of the 1.5 million people Centene said it served that year were Medicaid beneficiaries. Last year, that number had increased tenfold, largely as a result of Centene’s acquisitions of Health Net and WellCare in 2016 and 2020, respectively. Thanks to the Health Net deal, Centene now has more private-paying customers than Humana, but like Humana it doesn’t seem interested in increasing enrollment in its commercial operations. 

While Centene has focused on Medicaid–it claims to be the country’s largest Medicaid managed care company–Humana’s growth has been almost exclusively in Medicare Advantage. Last year, Humana reported nearly 5 million people in its Medicare Advantage plans, up from 1.7 million in 2010.

Both companies also get billions more from the government through the health plans they operate for the U.S. military. 

Bottom line: of the $209 billion in revenues those two companies took in last year, the vast majority came, one way or another, from you and me as taxpayers.

Meanwhile, people enrolled in their commercial plans not only experienced steep premium increases over the past decade, but they also now have to pay far more out of their own pockets before their coverage kicks in. Industry-wide, deductibles alone have more than doubled for most privately insured Americans during that time frame.