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Meanwhile, 17% of Americans say they're using buy now, pay later services for medical or dental care.
The seven largest publicly traded U.S. health insurance companies made a collective $71.3 billion in profits last year, and their CEOs took home a total of $146.1 million in compensation, according to an analysis released Wednesday by an ex-industry executive.
Wendell Potter, a former vice president for corporate communications at Cigna who now leads the nonprofit Center for Health and Democracy, compiled the data ahead of his recent testimony before the Senate Committee on Health, Education, Labor, and Pensions.
As Potter detailed for his newsletter, Health Care un-covered, the companies—UnitedHealth, CVS/Aetna, Cigna, Elevance, Humana, Centene, and Molina—boosted their profits by more than half a billion dollars from 2023 to 2024.
(Image: Health Care un-covered)
Alongside a chart detailing the companies' 2023 and 2024 revenues and profits, Potter published one showing each CEO's compensation. He also pointed out that their collective take-home pay is "enough to cover annual premiums for thousands of American families."
(Image: Health Care un-covered)
"So, what's driving the revenue surge?" Potter wrote. "Gouging. Insurers continued to jack up premiums for their commercial customers and overcharge the government."
He highlighted how investigations have exposed rampant fraud and upcoding with private Medicare Advantage plans and noted that "Medicaid managed care is a gold mine, too."
Potter further noted that "to the dismay of shareholders, the big seven insurers have had to admit that so far in 2025, they've paid more medical claims than they had expected, which means their profits were down somewhat during the first months of the year."
The expert warned that the American public should "expect even more financial pain (and difficulty getting the care you need) as these companies do all they can to get their profit margins back to where Wall Street wants them."
His warning comes as new polling makes clear that Americans are already feeling the pain from healthcare bills. Results released Monday by the Associated Press-NORC Center for Public Affairs Research show that 17% of U.S. adults have used buy now, pay later services for medical or dental care.
Most Americans are also stressed by healthcare costs. According to the poll, 42% of adults identified that as a major stressor, and another 36% said it's a minor stressor. Other sources of stress include grocery prices, housing, savings, and wages.
Healthcare could become an ever bigger source of stress soon, as Republicans' recently signed budget reconciliation package starts to strip millions of people of their insurance coverage, thanks to the law's attacks on Medicaid and the Affordable Care Act (ACA).
"Cuts to the ACA will raise premiums for almost 23M Americans by hundreds of dollars each year," Congressman Ro Khanna (D-Calif.) said on social media Monday. "Working and middle-class families can't afford that. We need to pass Medicare for All and make sure health insurance stays affordable for all Americans."
While more than 100 Democratic members of the U.S. House of Representatives and over a dozen senators support the Medicare for All Act, led by Rep. Pramila Jayapal (D-Wash.) and Sen. Bernie Sanders (I-Vt.), the proposal remains opposed by not only Republicans—who control both chambers—but also some corporate Democrats.
"All these stories paint a picture of a healthcare industry in desperate need of transformation," said the head of the think tank behind the awards.
The "winners" of the annual Shkreli Awards—named after notorious "pharma bro" Martin Shkreli and given to the 10 "worst examples of profiteering and dysfunction in healthcare"—include a Texas medical school that sold body parts of deceased people without relatives' consent, an alleged multibillion-dollar catheter scam, an oncologist who subjected patients to unnecessary cancer treatments, and a "monster monopoly" insurer.
The Shkreli Awards, now in their eighth year, are given annually by the Lown Institute, a Massachusetts-based think tank "advocating bold ideas for a just and caring system for health." A panel of 20 expert judges—who include physicians, professors, activists, and others—determine the winners.
This year's awardees are:
10: The University of North Texas Health Science Center "dissected and distributed unclaimed bodies without properly seeking consent from the deceased or their families" and supplied the parts "to medical students as well as major for-profit ventures like Medtronic and Johnson & Johnson," reporting revealed.
9:
Baby tongue-tie cutting procedures are "being touted as a cure for everything from breastfeeding difficulties to sleep apnea, scoliosis, and even constipation"—despite any conclusive evidence that the procedure is effective.
8: Zynex Medical is a company facing scrutiny for its billing practices related to nerve stimulation devices used for pain management.
7: Insurance giant Cigna is under fire for billing a family nearly $100,000 for an infant's medevac flight.
6: Seven suppliers allegedly ran a multibillion-dollar urinary catheter billing scam that affected hundreds of thousands of Medicare patients.
5: Memorial Medical Center in Las Cruces, New Mexico allegedly refused cancer treatment "to patients or demanding upfront payments, even from those with insurance."
4: Dr. Thomas C. Weiner is a Montana oncologist who allegedly "subjected a patient to unnecessary cancer treatments for over a decade," provided "disturbingly high doses of barbiturates to facilitate death in seriously ill patients, when those patients may not have actually been close to death," and "prescribed high doses of opioids to patients that did not need them." Weiner denies any wrongdoing.
3: Pharma giant Amgen was accused of pushing 960-milligram doses of its highly toxic cancer drug Lumakras, when "a lower 240mg dose offers similar efficacy with reduced toxicity"—but costs $180,000 less per patient annually at the lower dose.
2: UnitedHealth allegedly exploited "its vast physician network to maximize profits, often at the expense of patients and clinicians," including by pressuring doctors "to reduce time with patients and to practice aggressive medical coding tactics that make patients seem as sick as possible" in order to earn higher reimbursements from the federal government."
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1: Steward Health Care CEO Dr. Ralph de la Torre was accused of orchestrating "a dramatic healthcare debacle by prioritizing private equity profits over patient care" amid "debt and sale-leaseback schemes" and a bankruptcy that "left hospitals gutted, employees laid off, and communities underserved" as he reportedly walked away "with more than $250 million over the last four years as hospitals tanked."
"All these stories paint a picture of a healthcare industry in desperate need of transformation," Lown Institute president Dr. Vikas Saini said during the award ceremony, according toThe Guardian.
"Doing these awards every year shows us that this is nothing new," he added. "We're hoping that these stories illuminate what changes are needed."
The latest Shkreli Awards came just weeks after the brazen assassination of Brian Thompson, CEO of UnitedHealth subsidiary UnitedHealthcare. Although alleged gunman Luigi Mangione has pleaded not guilty, his reported manifesto—which rails against insurance industry greed—resonated with people across the country and sparked discussions about the for-profit healthcare system.
"Caremark, ESI, and Optum—as medication gatekeepers—have extracted millions of dollars off the backs of patients who need lifesaving medications," said one agency leader.
The Federal Trade Commission on Friday initiated a legal process against middlemen that collectively administer about 80% of all prescriptions in the United States, accusing them of artificially inflating the list price of insulin drugs and blocking patients from accessing cheaper products.
The FTC action targets the "Big Three" pharmacy benefit managers (PBMs): CVS Health's Caremark Rx, Cigna's Express Scripts (ESI), and UnitedHealth Group's OptumRx. It also involves their affiliated group purchasing organizations (GPOs): Zinc Health Services, Ascent Health Services, and Emisar Pharma Services.
"Millions of Americans with diabetes need insulin to survive, yet for many of these vulnerable patients, their insulin drug costs have skyrocketed over the past decade thanks in part to powerful PBMs and their greed," said Rahul Rao, deputy director of the FTC's Bureau of Competition.
"Caremark, ESI, and Optum—as medication gatekeepers—have extracted millions of dollars off the backs of patients who need lifesaving medications," Rao continued. "The FTC's administrative action seeks to put an end to the Big Three PBMs' exploitative conduct and marks an important step in fixing a broken system—a fix that could ripple beyond the insulin market and restore healthy competition to drive down drug prices for consumers."
The FTC's vote to begin the legal process by filing a complaint was 3-0. Led by Chair Lina Khan, the Democrats supported the move while the two Republicans, Commissioners Melissa Holyoak and Andrew N. Ferguson, recused.
The American Prospect executive editor David Dayen noted that "the complaint, which was filed in an administrative court, has not yet been made public, as it is undergoing redactions. Agency officials expect it to be made public on Monday."
However, in a statement after the vote, the FTC shared some details about the complaint's arguments that "Caremark, ESI, and Optum and their respective GPOs engaged in unfair methods of competition and unfair acts or practices under Section 5 of the FTC Act by incentivizing manufacturers to inflate insulin list prices, restricting patients' access to more affordable insulins on drug formularies, and shifting the cost of high list price insulins to vulnerable patient populations."
Rao emphasized that while the commission on Friday "exercised its discretion to move forward with suing only the PBMs and GPOs now, FTC staff's investigation has also shed light on the concerning and active role that the insulin manufacturers—Eli Lilly, Sanofi, and Novo Nordisk—play in the challenged conduct."
"All drug manufacturers should be on notice that their participation in the type of conduct challenged here can raise serious concerns, with a potential for significant consumer harm, and that the Bureau of Competition reserves the right to recommend naming drug manufacturers as defendants in any future enforcement actions over similar conduct," he said.
Emma Freer, senior policy analyst for healthcare at the American Economic Liberties Project, pointed out that "the FTC's case adds to the mounting, bipartisan criticism of the 'Big Three' PBMs, which for far too long have exploited their monopoly power to inflate drug prices and enrich shareholders at the expense of patients' health and pocketbooks."
"The lawsuit also exposes their industrywide abuse, using insulin—the price of which has soared over 1,200% since 1999—as a flagship example of how PBMs' rebate schemes distort markets and drive up costs for lifesaving drugs," Freer said. "While PBMs bear much of the blame, the FTC is right to also put brand-name manufacturers like Eli Lilly, Novo Nordisk, and Sanofi on notice for their role in this crisis. We're thrilled to see the commission bring this long overdue challenge against healthcare's most notorious middlemen, and hope to see it result in concrete reform and accountability."
As The New York Times reported:
Just weeks before the presidential election, the agency is tackling an issue that Vice President Kamala Harris has signaled an interest in. Campaigning at a community college in Raleigh, North Carolina, in August, Ms. Harris promised to "demand transparency from the middlemen who operate between Big Pharma and the insurance companies, who use opaque practices to raise your drug prices and profit off your need for medicine."
Former President Donald J. Trump has not campaigned on the issue, but in 2018, his administration proposed a sweeping change that would have threatened the benefit managers' business model. The proposal was never enacted. Mr. Trump's administration also created a model for capping Medicare patients' out-of-pocket costs for some insulin products that was later expanded under President [Joe] Biden.
The Times also noted that "some Republicans in Congress have proposed curbing some of the benefit managers' business practices. But other top Republicans have defended PBMs and said the FTC is overreaching."
Among the GOP's critics of PBMs is House Committee on Oversight and Accountability Chairman James Comer (R-Ky.), who highlighted his panel's investigations into the companies and praised the FTC move.
Another leading congressional critic of PBMs—and the country's failing for-profit healthcare system more broadly—is Senate Committee on Health, Education, Labor, and Pensions (HELP) Chair Bernie Sanders (I-Vt.), who caucuses with Democrats.
After a public pressure campaign led Eli Lilly, Novo Nordisk, and Sanofi to cut list prices of insulin products last year, Sanders held a hearing with their CEOs as well as PBM executives. At the time, he welcomed the voluntary reductions but also stressed that as "Americans pay outrageously high prices for prescription drugs, the pharmaceutical industry and the PBMs make enormous profits."
While the FTC's Friday action was widely praised—other than by the PBMs, who denied the allegations—some advocates hope the commission and other decision-makers will go even further in the future.
Stacy Mitchell, co-executive director of the Institute for Local Self-Reliance, called PBMs "some of the most predatory corporations in healthcare" and highlighted that "these companies have incredibly long rap sheets and convictions at the state level."
"I'm thrilled the FTC is going after these criminal enterprises," she said. "I hope this lawsuit, with its focus on kickbacks, is just the beginning. We also need action on how PBMs harm local pharmacies. Ultimately, these corporations need to be broken up."