Sarah London operates on the front lines of the toughest terrain in U.S. health care. She’s the CEO of Centene, an insurance giant providing government-sponsored plans at a time when funding is tight, costs are rising, and policy shifts create intense uncertainty.
While the St. Louis–based managed care insurer saw revenue grow almost 20% last year, to $194.8 billion, it posted a net loss of $6.7 billion. That was largely driven by a write-down that reflected the new reality for health care companies under the One Big Beautiful Bill Act championed by President Trump. Along with cutting federal Medicaid spending by more than $900 billion over 10 years, the law raises costs and reduces eligibility for people enrolled in Affordable Care Act (ACA) Marketplace plans.
Those changes are shaking up Centene’s core businesses. More than half of Centene’s revenue comes from Medicaid—it’s the country’s biggest Medicaid insurer—with the rest roughly divided between Medicare and Marketplace plans. While analysts don’t expect federal cuts to have a massive impact on Centene’s top line, they’re a sign of the challenges London faces.
Faced with new data that showed its ACA plans were enrolling both fewer and sicker people, London decided to withdraw earnings guidance last July, causing Centene’s share price to fall 40% in a single day, to an eight-year low.
