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Expand chart
Data: Company documents; Chart: Axios Visuals

UnitedHealth Group is mostly known as one of the country's largest health insurance carriers, but the massive conglomerate is increasingly making its money from things that have nothing to do with health insurance.

The bottom line: UnitedHealth doesn't just want to be your health insurer. It wants to be your doctor, your outpatient surgery center, your mail-order pharmacy and your drug price negotiator.

By the numbers: UnitedHealthcare is still UnitedHealth's most profitable unit, generating more than $10 billion in operating earnings in 2019 as a major carrier of employer and Medicare Advantage plans.

  • But UnitedHealth's Optum subsidiaries are close behind. Optum collected more profit in the fourth quarter of 2019 ($3 billion) than UnitedHealthcare ($2.1 billion). And that's not new: Optum has had a stronger Q4 than UnitedHealthcare in each of the past five years.
  • The last three months of the calendar year are usually the worst for health insurers. They pay out more for medical claims as more people reach their deductibles and out-of-pocket maximums.

Between the lines: The most profitable segment within Optum is OptumRx, which is part of the pharmacy benefit manager oligopoly that controls how drugs are paid for and which drugs are covered.

  • Rebates negotiated from drug companies, and other behind-the-scenes fees, have turned OptumRx into a cash cow — often at the expense of employers and their workers.
  • Optum's other units also are growing. They include a bank for health savings accounts, physician practices, urgent care clinics, surgery centers and almost any conceivable piece of technology and consulting used in health care.
Expand chart
Data: Company documents; Chart: Axios Visuals

Go deeper: UnitedHealth's political and financial heft just keeps growing

Go deeper

Biden's Day 1 challenges: Systemic racism

Photo illustration: Sarah Grillo/Axios. Photo: Kirsty O'Connor (PA Images)/Getty Images

Advocates are pushing President-elect Biden to tackle systemic racism with a Day 1 agenda that includes ending the detention of migrant children and expanding DACA, announcing a Justice Department investigation of rogue police departments and returning some public lands to Indigenous tribes.

Why it matters: Biden has said the fight against systemic racism will be one of the top goals of his presidency — but the expectations may be so high that he won't be able to meet them.

Caitlin Owens, author of Vitals
2 hours ago - Health

Most Americans are still vulnerable to the coronavirus

Adapted from Bajema, et al., 2020, "Estimated SARS-CoV-2 Seroprevalence in the US as of September 2020"; Cartogram: Andrew Witherspoon/Axios

As of September, the vast majority of Americans did not have coronavirus antibodies, according to a new study published in JAMA Internal Medicine.

Why it matters: As the coronavirus spreads rapidly throughout most of the country, most people remain vulnerable to it.

Trump set to appear at Pennsylvania GOP hearing on voter fraud claims

President Trumpat the White House on Tuesday. Photo: Chip Somodevilla/Getty Images

President Trump is due to join his personal lawyer Rudy Giuliani in Gettysburg, Pennsylvania, Wednesday at a Republican-led state Senate Majority Policy Committee hearing to discuss alleged election irregularities.

Why it matters: This would be his first trip outside of the DMV since Election Day and comes shortly after GSA ascertained the results, formally signing off on a transition to President-elect Biden.

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